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NPI Code Detail

MEDICARE: ROBIN GRESHAM

MEDICARE:   ROBIN  GRESHAM
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
1224Z00000XOccupational Therapy Assistant211025TX

Other Identifiers

General Provider Information

NPI Number : 1326481656
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN GRESHAM
Provider Business Mailing Address
First Line : 305 NE LOOP 820
Second Line : BUSINESS TOWER 1; SUITE 200
City : HURST
State : TX
Zip : 76053-7209
Country : US
Telephone Number : 817-292-8787
Fax Number : 817-789-6849
Provider Business Practice Location Address
First Line : 12941 NORTH FWY
Second Line : SUITE 401
City : HOUSTON
State : TX
Zip : 77060-1240
Country : US
Telephone Number : 281-214-8200
Fax Number : 817-789-6849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2013
Last Update Date : 04/17/2013

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