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NPI Code Detail

MEDICARE: MICHELLE RODRIGUEZ OTR/L

MEDICARE: MICHELLE RODRIGUEZ OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist14186CA

General Provider Information

NPI Number : 1164835377
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE RODRIGUEZ OTR/L
Provider Business Mailing Address
First Line : 141 HILLSIDE BLVD
Second Line :
City : DALY CITY
State : CA
Zip : 94014-1877
Country : US
Telephone Number : 206-271-9040
Fax Number :
Provider Business Practice Location Address
First Line : 14500 FRUITVALE AVE
Second Line :
City : SARATOGA
State : CA
Zip : 95070-6165
Country : US
Telephone Number : 408-741-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2014
Last Update Date : 06/05/2014

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