Provider Demographics
NPI:1114040953
Name:RODRIGUEZ, SHARON DETERS (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DETERS
Last Name:RODRIGUEZ
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 1:2610 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5500
Mailing Address - Country:US
Mailing Address - Phone:847-741-4352
Mailing Address - Fax:
Practice Address - Street 1:2610 BOXWOOD DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-5500
Practice Address - Country:US
Practice Address - Phone:847-741-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics