Provider Demographics
NPI:1164677134
Name:RODRIGUEZ, DEBORAH (OT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
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 1:102 PALO ALTO RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3758
Mailing Address - Country:US
Mailing Address - Phone:210-922-1785
Mailing Address - Fax:210-922-1782
Practice Address - Street 1:102 PALO ALTO RD.
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211
Practice Address - Country:US
Practice Address - Phone:210-922-1785
Practice Address - Fax:210-922-1782
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101015OtherOCCUPATIONAL THERAPY LICENSE