Provider Demographics
NPI:1043384068
Name:ROBERTSON, JAMES EDWARD (OTR)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10214 DREAMLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4106
Mailing Address - Country:US
Mailing Address - Phone:210-269-6252
Mailing Address - Fax:210-541-9363
Practice Address - Street 1:12770 CIMARRON PATH
Practice Address - Street 2:SUITE 132
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3427
Practice Address - Country:US
Practice Address - Phone:210-561-5777
Practice Address - Fax:210-561-5770
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist