Provider Demographics
NPI:1225486152
Name:RODRIGUEZ, IVETT AMADA (COTA)
Entity Type:Individual
Prefix:
First Name:IVETT
Middle Name:AMADA
Last Name: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 1:17537 SW 153RD PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6305
Mailing Address - Country:US
Mailing Address - Phone:786-502-0506
Mailing Address - Fax:
Practice Address - Street 1:17537 SW 153RD PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-6305
Practice Address - Country:US
Practice Address - Phone:786-502-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13781224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant