Basic Information
Provider Information
NPI: 1679778997
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRINCE
FirstName: ROBYN
MiddleName: LYNNE
NamePrefix: MRS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 927 21ST ST SE
Address2:  
City: CEDAR RAPIDS
State: IA
PostalCode: 524033318
CountryCode: US
TelephoneNumber: 3193101960
FaxNumber:  
Practice Location
Address1: 3661 ROCHESTER AVE
Address2:  
City: IOWA CITY
State: IA
PostalCode: 522459271
CountryCode: US
TelephoneNumber: 3193517460
FaxNumber: 3193416229
Other Information
ProviderEnumerationDate: 06/18/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X01156IAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home