Provider Demographics
NPI:1144476631
Name:MOORE, ROBIN L (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:ROBIN
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:2437 E KEYS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3207
Mailing Address - Country:US
Mailing Address - Phone:217-299-0952
Mailing Address - Fax:217-679-2497
Practice Address - Street 1:1998 N WALNUT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-8444
Practice Address - Country:US
Practice Address - Phone:217-299-0952
Practice Address - Fax:217-679-2497
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist