Provider Demographics
NPI:1104906130
Name:WOODS, ROBIN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:WOODS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:DAMERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1921 STONECIPHER DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3439
Mailing Address - Country:US
Mailing Address - Phone:580-421-4570
Mailing Address - Fax:580-421-6283
Practice Address - Street 1:817 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-1800
Practice Address - Country:US
Practice Address - Phone:580-387-2726
Practice Address - Fax:580-387-2713
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA616208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKTA616OtherOK LICENSE