Healthcare Provider Details

I. General information

NPI: 1710099916
Provider Name (Legal Business Name): GLENYS AURORA RODRIGUEZ O.T.R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 NW 122ND PL
MIAMI FL
33182-2013
US

IV. Provider business mailing address

714 NW 122ND PL
MIAMI FL
33182-2013
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-1480
  • Fax:
Mailing address:
  • Phone: 305-551-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: