Provider Demographics
NPI:1710595756
Name:RODRIGUEZ, LANI DANAE (COTA)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:DANAE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:DANAE
Other - Last Name:ALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 ELIZABETH BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2313
Mailing Address - Country:US
Mailing Address - Phone:817-279-2521
Mailing Address - Fax:
Practice Address - Street 1:4515 VILLAGE CREEK RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-4158
Practice Address - Country:US
Practice Address - Phone:817-451-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215842224ZF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & Swallowing