Provider Demographics
NPI:1356465892
Name:RODRIGUEZ, JODI SUE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:SUE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:89 WEID DRIVE
Mailing Address - Street 2:BEACON BROOK HEALTH CENTER
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770
Mailing Address - Country:US
Mailing Address - Phone:203-729-9889
Mailing Address - Fax:203-720-4082
Practice Address - Street 1:89 WEID DRIVE
Practice Address - Street 2:BEACON BROOK HEALTH CENTER
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770
Practice Address - Country:US
Practice Address - Phone:203-729-9889
Practice Address - Fax:203-720-4082
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000845224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant