Provider Demographics
NPI:1134234065
Name:SEGREST, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SEGREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SEGREST LN
Mailing Address - Street 2:
Mailing Address - City:SHORTER
Mailing Address - State:AL
Mailing Address - Zip Code:36075-3117
Mailing Address - Country:US
Mailing Address - Phone:334-727-4184
Mailing Address - Fax:
Practice Address - Street 1:1125 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2313
Practice Address - Country:US
Practice Address - Phone:334-284-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2352OtherLICENSE #