MEDICARE: ABIGAIL 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
1	225X00000X	Occupational Therapist	17-0886	NV

General Provider Information

NPI Number	:	1477083210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL RODRIGUEZ OTR/L

Provider Business Mailing Address
First Line	:	10380 BROOKE RISE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5176
Country	:	US
Telephone Number	:	484-612-2256
Fax Number	:

Provider Business Practice Location Address
First Line	:	9260 W SUNSET RD STE 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4903
Country	:	US
Telephone Number	:	702-339-8770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	06/28/2021

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