Provider Demographics
NPI:1205087764
Name:ROBISON, HEATHER L (OTR)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:ROBISON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:45-545 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1943
Mailing Address - Country:US
Mailing Address - Phone:808-247-2220
Mailing Address - Fax:808-235-3676
Practice Address - Street 1:45-545 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-1943
Practice Address - Country:US
Practice Address - Phone:808-247-2220
Practice Address - Fax:808-235-3676
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109135225X00000X
HIOT 583225X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0944746-02Medicaid
74-2745294OtherTAX ID
0031DGOtherBC/BS
0031DGOtherBC/BS