Provider Demographics
NPI:1114015104
Name:RODRIGUEZ, MARICELA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARICELA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N 23RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6058
Mailing Address - Country:US
Mailing Address - Phone:956-618-2199
Mailing Address - Fax:956-618-0899
Practice Address - Street 1:3200 N 23RD ST STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6058
Practice Address - Country:US
Practice Address - Phone:956-618-2199
Practice Address - Fax:956-618-0899
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111839225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6345OtherBCBS PROVIDER