Provider Demographics
NPI:1710442181
Name:RODRIGUES, MARCIA C (COTA)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:C
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CLENILDA
Other - Middle Name:C
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 SUMMERSET CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4017
Mailing Address - Country:US
Mailing Address - Phone:973-820-6258
Mailing Address - Fax:
Practice Address - Street 1:520 SUMMERSET CT
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4017
Practice Address - Country:US
Practice Address - Phone:973-820-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16978224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant