Provider Demographics
NPI:1093393514
Name:PEREZ RODRIGUEZ, MARICE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARICE
Middle Name:
Last Name:PEREZ RODRIGUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 SW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7837
Mailing Address - Country:US
Mailing Address - Phone:786-389-9995
Mailing Address - Fax:
Practice Address - Street 1:1710 SW 87TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7837
Practice Address - Country:US
Practice Address - Phone:786-389-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18017224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18017OtherPROFESSIONAL LICENSE