Provider Demographics
NPI:1881962280
Name:TACKETT, ROBIN LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:TACKETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 DRESDEN ADAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:OH
Mailing Address - Zip Code:43821-9417
Mailing Address - Country:US
Mailing Address - Phone:740-754-3834
Mailing Address - Fax:
Practice Address - Street 1:1100 E STATE RD
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9446
Practice Address - Country:US
Practice Address - Phone:740-498-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT4285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist