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NPI Code Detail

MEDICARE: MR. CHARLES ROBERTS OTR/L

MEDICARE: MR. CHARLES ROBERTS 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
1225XP0200XPediatric Occupational Therapist007385-1NY

General Provider Information

NPI Number : 1730499765
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES ROBERTS OTR/L
Provider Business Mailing Address
First Line : 85 REDDICK LN
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-1959
Country : US
Telephone Number : 585-594-1114
Fax Number :
Provider Business Practice Location Address
First Line : 690 SAINT PAUL ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14605-1709
Country : US
Telephone Number : 585-324-9956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2010
Last Update Date : 10/08/2010

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