MEDICARE: AZIAH ROBINSON OTR/L

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	225X00000X	Occupational Therapist	O-T1428	AR

General Provider Information

NPI Number	:	1053712950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZIAH ROBINSON OTR/L

Provider Business Mailing Address
First Line	:	2520 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4214
Country	:	US
Telephone Number	:	501-982-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4212
Country	:	US
Telephone Number	:	501-982-0528
Fax Number	:

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	12/12/2024

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Directions to “ AZIAH ROBINSON OTR/L” Practice Location

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