Provider Demographics
NPI:1104070580
Name:STURDEVANT, ROBYN RENEE (COTA)
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:RENEE
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:ROBYN
Other - Middle Name:RENEE
Other - Last Name:HARVELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:5967 ENNIS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13054-3111
Mailing Address - Country:US
Mailing Address - Phone:315-363-2028
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003054225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology