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General NPI Number Information
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NPI Number | 1427533470
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Entity Type | Individual
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Provider Name | DERYL JC ROBSON
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Gender | Female
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 150 MIDWAY RD
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City | CRANSTON
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State | RI
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Zip | 02920-5710
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Country | US
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Telephone | 401-942-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 336 SEA VIEW AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-4820
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Country | US
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Telephone | 401-487-2308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 12903
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License Number State | MA
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