Healthcare Provider Details

I. General information

NPI: 1831861228
Provider Name (Legal Business Name): ABIGAIL ELIZABETH RODRIGUEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13819 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1066
US

IV. Provider business mailing address

11317 NW 95TH ST
YUKON OK
73099-7754
US

V. Phone/Fax

Practice location:
  • Phone: 405-467-6782
  • Fax:
Mailing address:
  • Phone: 405-509-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5577
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: