MEDICARE: JENNIFER M 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	024383	NY

General Provider Information

NPI Number	:	1851931216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M RODRIGUEZ OTR/L

Provider Business Mailing Address
First Line	:	348 89TH ST APT 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5628
Country	:	US
Telephone Number	:	347-628-6156
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 89TH ST APT 1F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5628
Country	:	US
Telephone Number	:	347-628-6156
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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