Individual
JACKIE LYNETTE ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3727 PARKER BLVD, PUEBLO, CO 81008-2218
(719) 585-3400
Mailing address
5302 ARTISTIC CIR, COLORADO SPRINGS, CO 80917-2212
(512) 567-9565
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT.0005855
CO
227900000X
Registered Respiratory Therapist
RTL.0005892
CO
Other
Enumeration date
02/26/2019
Last updated
12/27/2019
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