Provider Demographics
NPI:1609417377
Name:RODRIGUEZ, OMARY CHARLOTTE (SLT)
Entity Type:Individual
Prefix:MRS
First Name:OMARY
Middle Name:CHARLOTTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CALLE MARICAO
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2754
Mailing Address - Country:US
Mailing Address - Phone:939-226-2212
Mailing Address - Fax:
Practice Address - Street 1:90 CALLE MARICAO
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:939-226-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR73212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty