Basic Information
Provider Information
NPI: 1003004789
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POSTON
FirstName: ROBIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2502 E EMPIRE ST
Address2: SUITE 250
City: BLOOMINGTON
State: IL
PostalCode: 617043738
CountryCode: US
TelephoneNumber: 3094541616
FaxNumber: 3094545167
Practice Location
Address1: 2200 FORT JESSE RD
Address2: SUITE 250
City: NORMAL
State: IL
PostalCode: 617616286
CountryCode: US
TelephoneNumber: 3094541616
FaxNumber: 3094545167
Other Information
ProviderEnumerationDate: 10/09/2007
LastUpdateDate: 04/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X056-003678ILY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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