Provider Demographics
NPI:1659383925
Name:CABALLERO-RODRIGUEZ, MARIANNE RENEE (OT/L, CHT)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:RENEE
Last Name:CABALLERO-RODRIGUEZ
Suffix:
Gender:F
Credentials:OT/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7824 SOUTHWORTH RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-8971
Mailing Address - Country:US
Mailing Address - Phone:209-763-2528
Mailing Address - Fax:209-763-2947
Practice Address - Street 1:1919 GRAND CANAL BLVD
Practice Address - Street 2:SUITE C-4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8114
Practice Address - Country:US
Practice Address - Phone:209-956-8737
Practice Address - Fax:209-956-2586
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2470225000000X, 225X00000X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1172170OtherFIRST HEALTH
CAOT0024700OtherBLUE SHIELD PIN
CAZZZ07989ZOtherBLUE SHIELD GROUP
CA171713600OtherDEPARTMENT OF LABOR
CA5268870001OtherDMERC
ARP00066568OtherMEDICARE RAILROAD
CA5530198OtherAETNA
CA171713600OtherDEPARTMENT OF LABOR