Provider Demographics
NPI:1013544964
Name:RODRIGUEZ, ADA ISABEL (MSOT)
Entity Type:Individual
Prefix:
First Name:ADA ISABEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SADDLE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1901
Mailing Address - Country:US
Mailing Address - Phone:973-971-4580
Mailing Address - Fax:
Practice Address - Street 1:6 SADDLE RD
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1901
Practice Address - Country:US
Practice Address - Phone:973-971-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00433500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist