Healthcare Provider Details

I. General information

NPI: 1114440252
Provider Name (Legal Business Name): MARIA RODGERS B.A, E.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HIGHWAY 27 STE B201
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

1480 HAMMOCK RIDGE RD APT 5202
CLERMONT FL
34711-6383
US

V. Phone/Fax

Practice location:
  • Phone: 135-239-4021
  • Fax: 352-394-0212
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: