MEDICARE: MISS GINA MARIE RODRIGUEZ 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	TOC103134	PA

General Provider Information

NPI Number	:	1861934523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GINA MARIE RODRIGUEZ OTR/L

Provider Business Mailing Address
First Line	:	213 SPYGLASS CT
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-6722
Country	:	US
Telephone Number	:	570-807-9731
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 SPYGLASS CT
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-6722
Country	:	US
Telephone Number	:	570-807-9731
Fax Number	:

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

Provider Enumeration Date	:	11/12/2016
Last Update Date	:	11/12/2016

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