Healthcare Provider Details

I. General information

NPI: 1164677134
Provider Name (Legal Business Name): DEBORAH RODRIGUEZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD. SUITE 140
SAN ANTONIO TX
78211
US

IV. Provider business mailing address

102 PALO ALTO RD SUITE 140
SAN ANTONIO TX
78211-3758
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-1785
  • Fax: 210-922-1782
Mailing address:
  • Phone: 210-922-1785
  • Fax: 210-922-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: