Provider Demographics
NPI:1679915037
Name:CREDLE, ROBYN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:
Last Name:CREDLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 US HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-8660
Mailing Address - Country:US
Mailing Address - Phone:910-329-4444
Mailing Address - Fax:
Practice Address - Street 1:624 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-8660
Practice Address - Country:US
Practice Address - Phone:910-329-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2102224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant