Provider Demographics
NPI:1326355603
Name:RODRIGUEZ, MARCO A (OT)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 RAINBOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8106
Mailing Address - Country:US
Mailing Address - Phone:915-204-8431
Mailing Address - Fax:800-971-7978
Practice Address - Street 1:1920 N ZARAGOZA RD STE 108
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4656
Practice Address - Country:US
Practice Address - Phone:800-971-7970
Practice Address - Fax:800-971-7978
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist