MEDICARE: MRS. GLORIA ADRIANA RODRIGUEZ OTR

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	110390	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336173368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA ADRIANA RODRIGUEZ OTR

Provider Business Mailing Address
First Line	:	709 S RAUL LONGORIA RD
Second Line	:	SUITE G
City	:	EDINBURG
State	:	TX
Zip	:	78542-5238
Country	:	US
Telephone Number	:	956-381-4545
Fax Number	:	956-381-4541

Provider Business Practice Location Address
First Line	:	709 S RAUL LONGORIA RD
Second Line	:	SUITE G
City	:	EDINBURG
State	:	TX
Zip	:	78542-5238
Country	:	US
Telephone Number	:	956-381-4545
Fax Number	:	956-381-4541

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/20/2011

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Directions to “ MRS. GLORIA ADRIANA RODRIGUEZ OTR” Practice Location

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