Healthcare Provider Details

I. General information

NPI: 1346405149
Provider Name (Legal Business Name): MICHELLE MARIE RODRIGUEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 17TH ST STE 407
COLUMBUS GA
31901-3514
US

IV. Provider business mailing address

1167 GRIGGS ST
DUPONT WA
98327-8755
US

V. Phone/Fax

Practice location:
  • Phone: 334-756-1126
  • Fax: 334-156-6561
Mailing address:
  • Phone: 706-573-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60589937
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: