Provider Demographics
NPI:1104106970
Name:ROBERSON, AMY N (COTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:N
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:2117 E TYLER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7212
Mailing Address - Country:US
Mailing Address - Phone:956-440-0580
Mailing Address - Fax:956-440-0584
Practice Address - Street 1:2117 E TYLER AVE STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7212
Practice Address - Country:US
Practice Address - Phone:956-440-0580
Practice Address - Fax:956-440-0584
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211323224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant