Individual
MR. ROBERT TREVOR DIVETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7920 WYOMING BLVD NE STE A1, ALBUQUERQUE, NM 87109-6020
(505) 420-4126
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
NM
225X00000X
Occupational Therapist
Primary
OT-2024-0054
NM
235Z00000X
Speech-Language Pathologist
SLP7471
NM
Other
Enumeration date
01/14/2022
Last updated
08/22/2024
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