MEDICARE: MR. MARCO A RODRIGUEZ OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	104537	TX

General Provider Information

NPI Number	:	1326355603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCO A RODRIGUEZ OT

Provider Business Mailing Address
First Line	:	1404 RAINBOW RIDGE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-8106
Country	:	US
Telephone Number	:	915-204-8431
Fax Number	:	800-971-7978

Provider Business Practice Location Address
First Line	:	1920 N ZARAGOZA RD STE 108
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4656
Country	:	US
Telephone Number	:	800-971-7970
Fax Number	:	800-971-7978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/26/2013

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