Healthcare Provider Details

I. General information

NPI: 1407476104
Provider Name (Legal Business Name): JAI-LISA MARIE RODRIGUEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 66TH STREET NORTH
ST. PETERSBURG FL
33709
US

IV. Provider business mailing address

4655 66TH STREET NORTH
ST. PETERSBURG FL
33709
US

V. Phone/Fax

Practice location:
  • Phone: 727-546-4700
  • Fax: 727-549-8108
Mailing address:
  • Phone: 727-546-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT24928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT27767
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT27767
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT24928
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24928
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27767
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT24928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: