=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386961126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CERVENKA AND RODRIGUEZ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 ENTERPRISE DR SUITE 2505
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-5814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-409-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 ENTERPRISE DR SUITE 2505
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-5814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-409-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BIANCA RODRIGUEZ
-----------------------------------------------------
Credential | DT
-----------------------------------------------------
Telephone | 708-409-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------