Provider Demographics
NPI:1225617798
Name:RODRIGUEZ VEGA, KEISHLA MARIE (OT)
Entity Type:Individual
Prefix:MISS
First Name:KEISHLA
Middle Name:MARIE
Last Name:RODRIGUEZ VEGA
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 1:1682 BAY BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7482
Mailing Address - Country:US
Mailing Address - Phone:939-242-1585
Mailing Address - Fax:
Practice Address - Street 1:1682 BAY BREEZE DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7482
Practice Address - Country:US
Practice Address - Phone:939-242-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21493225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist