Provider Demographics
NPI:1922200625
Name:RODRIGUEZ, CARMEN M (OTL)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE PLAZA 38 MQ-32
Mailing Address - Street 2:MONTE CLARO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-787-7789
Mailing Address - Fax:787-787-7789
Practice Address - Street 1:CALLE PLAZA 38 MQ-32
Practice Address - Street 2:MONTE CLARO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-787-7789
Practice Address - Fax:787-787-7789
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist