Basic Information
Provider Information | |||||||||
NPI: | 1932181203 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROBINS | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS OTRL | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 818 NEWTOWN RD | ||||||||
Address2: |   | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234621116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574738016 | ||||||||
FaxNumber: | 7574733580 | ||||||||
Practice Location | |||||||||
Address1: | 818 NEWTOWN RD | ||||||||
Address2: |   | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234621116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574738016 | ||||||||
FaxNumber: | 7574733580 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2005 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119003821 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 11448561 | 01 |   | CAQH | OTHER | 7537632 | 01 |   | AETNA | OTHER | 4980093 | 01 | VA | PREMIER HEALTH PLAN | OTHER | 6400313 | 01 |   | UNITED HEALTH CARE | OTHER | 007328 | 01 |   | ANTHEM BLUE CROSS GROUP | OTHER | 35062 | 01 |   | OPTIMA | OTHER | 4980093 | 05 | VA |   | MEDICAID | 176581 | 01 |   | ANTHEM BLUE CROSS | OTHER | 5275769 | 01 |   | AETNA GROUP | OTHER | 9116460 | 01 | VA | MEDICAID DMC | OTHER | 350034 | 01 |   | OPTIMA GROUP | OTHER |