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General NPI Number Information
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NPI Number | 1477977056
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Entity Type | Individual
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Provider Name | CHARLES ROBERTSON MS
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Gender | Male
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 169 TEQUESTA DR STE 24E
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City | TEQUESTA
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State | FL
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Zip | 33469-4700
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Country | US
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Telephone | 561-747-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 7050 ISLA VISTA DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-3065
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 004115
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT21819
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License Number State | FL
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