Provider Demographics
NPI:1396997573
Name:CONNOLLY, ROBYN B (OTR)
Entity type:Individual
Prefix:MISS
First Name:ROBYN
Middle Name:B
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S BROADWAY
Mailing Address - Street 2:APT B9
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5611
Mailing Address - Country:US
Mailing Address - Phone:914-909-4342
Mailing Address - Fax:
Practice Address - Street 1:330 S BROADWAY
Practice Address - Street 2:APT B9
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5611
Practice Address - Country:US
Practice Address - Phone:914-909-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0102591225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics