Provider Demographics
NPI:1144367715
Name:ROBINSON, STANLEY MELVIN (OTR)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:MELVIN
Last Name:ROBINSON
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 1:15125 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-2733
Mailing Address - Country:US
Mailing Address - Phone:708-906-9189
Mailing Address - Fax:
Practice Address - Street 1:15125 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-2733
Practice Address - Country:US
Practice Address - Phone:708-906-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12466456225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist