Basic Information
Provider Information
NPI: 1265568059
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SKOWRONSKI
FirstName: ROBIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 425
Address2:  
City: WATERTOWN
State: CT
PostalCode: 067950425
CountryCode: US
TelephoneNumber: 8609453012
FaxNumber: 8609459854
Practice Location
Address1: 900 MAIN ST
Address2:  
City: OAKVILLE
State: CT
PostalCode: 067791999
CountryCode: US
TelephoneNumber: 8609453012
FaxNumber: 8609459854
Other Information
ProviderEnumerationDate: 02/26/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X003227CTY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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