Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT9733 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT9733 | FL |
NPI | 1811196736 |
---|---|
Provider Name | Gary P Robertson |
First Address | Beverly Hills, FL 34464-0277 |
Second Address | Crystal River, FL 34429-5751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 09/02/2008 |