Provider Demographics
NPI:1427533470
Name:ROBSON, DERYL JC
Entity type:Individual
Prefix:
First Name:DERYL
Middle Name:JC
Last Name:ROBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DERYL
Other - Middle Name:JC
Other - Last Name:ROBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:336 SEA VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-4820
Mailing Address - Country:US
Mailing Address - Phone:401-487-2308
Mailing Address - Fax:
Practice Address - Street 1:150 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5710
Practice Address - Country:US
Practice Address - Phone:401-942-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12903225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics