Provider Demographics
NPI:1417300815
Name:RODRIGUEZ, KAISHA
Entity Type:Individual
Prefix:
First Name:KAISHA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRANCH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BRANCH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1923
Practice Address - Country:US
Practice Address - Phone:978-973-0643
Practice Address - Fax:978-984-5943
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist