Provider Demographics
NPI:1487330783
Name:ROBINSON, PAIGE ALEXANDRA
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALEXANDRA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975
Mailing Address - Country:US
Mailing Address - Phone:574-847-1332
Mailing Address - Fax:
Practice Address - Street 1:901 MAPLEWOOD LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975
Practice Address - Country:US
Practice Address - Phone:574-847-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3850087252222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist