Provider Demographics
NPI:1235848359
Name:RODRIGUEZ, JOANNE MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
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 1:23 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1709
Mailing Address - Country:US
Mailing Address - Phone:347-236-4717
Mailing Address - Fax:
Practice Address - Street 1:23 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1709
Practice Address - Country:US
Practice Address - Phone:347-236-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty