Provider Demographics
NPI:1225220809
Name:OETH, ROBYN RENEE (MA, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:RENEE
Last Name:OETH
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 52ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2826
Mailing Address - Country:US
Mailing Address - Phone:727-289-6212
Mailing Address - Fax:727-289-6212
Practice Address - Street 1:595 52ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2826
Practice Address - Country:US
Practice Address - Phone:727-289-6212
Practice Address - Fax:727-289-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT001834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892456200Medicaid