MEDICARE: MS. GLADYS J RODRIGUEZ OTRL

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	004859-1	NY

General Provider Information

NPI Number	:	1841442050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLADYS J RODRIGUEZ OTRL

Provider Business Mailing Address
First Line	:	3777 INDEPENDENCE AVE
Second Line	:	APT. 16A
City	:	BRONX
State	:	NY
Zip	:	10463-1409
Country	:	US
Telephone Number	:	718-796-7614
Fax Number	:	718-601-7422

Provider Business Practice Location Address
First Line	:	3777 INDEPENDENCE AVE
Second Line	:	APT. 16A
City	:	BRONX
State	:	NY
Zip	:	10463-1409
Country	:	US
Telephone Number	:	718-796-7614
Fax Number	:	718-601-7422

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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