Provider Demographics
NPI:1093977977
Name:RODRIGUEZ ROSADO, MARISOL (OT)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:RODRIGUEZ ROSADO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1431
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-7002
Mailing Address - Country:US
Mailing Address - Phone:787-450-4349
Mailing Address - Fax:
Practice Address - Street 1:ROAD 159 A1
Practice Address - Street 2:URB SAN FELIZ
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-450-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR789225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics