=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851959274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDRA ROBBINS LAT,ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2019
-----------------------------------------------------
Last Update Date | 05/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 W CENTER ST
-----------------------------------------------------
City | WEST BRIDGEWATER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02379-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-894-1220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 REED AVE
-----------------------------------------------------
City | NORTH ATTLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02760-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-595-6513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 3087
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------