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General NPI Number Information
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NPI Number | 1962290445
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Entity Type | Individual
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Provider Name | OSA LEE ROBERTSON
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Gender | Female
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 200 CLUBHOUSE VISTA RD
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City | ALTOONA
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State | FL
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Zip | 32702-9639
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Country | US
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Telephone | 800-343-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 MARION COUNTY RD LOT 116
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City | WEIRSDALE
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State | FL
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Zip | 32195-5107
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Country | US
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Telephone | 484-764-6521
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 05119
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License Number State | FL
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