Provider Demographics
NPI:1316015035
Name:RODMON, GISSEL LUCIA (OTR L)
Entity Type:Individual
Prefix:
First Name:GISSEL
Middle Name:LUCIA
Last Name:RODMON
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 108TH TER
Mailing Address - Street 2:APT 102
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4086
Mailing Address - Country:US
Mailing Address - Phone:786-859-1038
Mailing Address - Fax:
Practice Address - Street 1:20704 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1146
Practice Address - Country:US
Practice Address - Phone:305-933-5887
Practice Address - Fax:305-399-8991
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist