MEDICARE: OPHELIA BEATRICE ROBINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	RU416770	OH
2	164W00000X	Licensed Practical Nurse	195159	OH

General Provider Information

NPI Number	:	1023763059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OPHELIA BEATRICE ROBINSON

Provider Business Mailing Address
First Line	:	4938 MAPLECREEK DR APT B
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-1662
Country	:	US
Telephone Number	:	937-271-6240
Fax Number	:	937-271-6240

Provider Business Practice Location Address
First Line	:	4938 MAPLECREEK DR APT B
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-1662
Country	:	US
Telephone Number	:	937-271-6240
Fax Number	:	937-271-6240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	02/19/2026

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