Provider Demographics
NPI:1487266508
Name:ROBERTS, JAMES M (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:M
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1401 S LAVENTURE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-6033
Mailing Address - Country:US
Mailing Address - Phone:360-424-7041
Mailing Address - Fax:360-424-2456
Practice Address - Street 1:1017 20TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2505
Practice Address - Country:US
Practice Address - Phone:360-424-7041
Practice Address - Fax:360-424-2456
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61311258225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty