Healthcare Provider Details

I. General information

NPI: 1689225047
Provider Name (Legal Business Name): NICOLE VARGAS RODULFO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 24TH RD
OCALA FL
34471-6073
US

IV. Provider business mailing address

1801 SE 24TH RD
OCALA FL
34471-6073
US

V. Phone/Fax

Practice location:
  • Phone: 407-413-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number17443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: