MEDICARE: MRS. NANCY ANN RODMAN OTR/L

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	0311	AZ

General Provider Information

NPI Number	:	1801068721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY ANN RODMAN OTR/L

Provider Business Mailing Address
First Line	:	3825 E BEAVER VISTA RD
Second Line	:
City	:	RIMROCK
State	:	AZ
Zip	:	86335-5458
Country	:	US
Telephone Number	:	623-521-5387
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 E BEAVER VISTA RD
Second Line	:
City	:	RIMROCK
State	:	AZ
Zip	:	86335-5458
Country	:	US
Telephone Number	:	623-521-5387
Fax Number	:

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	02/26/2020

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