MEDICARE: MS. MARIANNE RENEE CABALLERO-RODRIGUEZ OT/L, CHT

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	225000000X	Orthotic Fitter	2470	CA
2	225X00000X	Occupational Therapist	2470	CA
3	225XH1200X	Hand Occupational Therapist	2470	CA
4	225XN1300X	Neurorehabilitation Occupational Therapist	2470	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00066568	OTHER	AR	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1172170	OTHER	CA	FIRST HEALTH
2	OT0024700	OTHER	CA	BLUE SHIELD PIN
3	ZZZ07989Z	OTHER	CA	BLUE SHIELD GROUP
4	171713600	OTHER	CA	DEPARTMENT OF LABOR
5	5268870001	OTHER	CA	DMERC
7	5530198	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1659383925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIANNE RENEE CABALLERO-RODRIGUEZ OT/L, CHT

Provider Business Mailing Address
First Line	:	7824 SOUTHWORTH RD
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8971
Country	:	US
Telephone Number	:	209-763-2528
Fax Number	:	209-763-2947

Provider Business Practice Location Address
First Line	:	1919 GRAND CANAL BLVD
Second Line	:	SUITE C-4
City	:	STOCKTON
State	:	CA
Zip	:	95207-8114
Country	:	US
Telephone Number	:	209-956-8737
Fax Number	:	209-956-2586

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	10/24/2012

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