Provider Demographics
NPI:1053624940
Name:LAWRENCE, ROBERT ALLEN III (COTA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:LAWRENCE
Suffix:III
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 GREEN RIVER DR
Mailing Address - Street 2:APT. 1205
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8046
Mailing Address - Country:US
Mailing Address - Phone:812-686-1607
Mailing Address - Fax:
Practice Address - Street 1:3114 GREEN RIVER DR
Practice Address - Street 2:APT. 1205
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8046
Practice Address - Country:US
Practice Address - Phone:812-686-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001861A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant