MEDICARE: BROOKE RODRIGUEZ

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	224Z00000X	Occupational Therapy Assistant	345808	LA

General Provider Information

NPI Number	:	1669363446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE RODRIGUEZ

Provider Business Mailing Address
First Line	:	104 QUEENSBERRY DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 WOODLAND DR
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-3442
Country	:	US
Telephone Number	:	337-234-7018
Fax Number	:

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

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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Directions to “ BROOKE RODRIGUEZ ” Practice Location

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