Provider Demographics
NPI:1780135202
Name:RODRIGUEZ, ERIC (OTR)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 N 37TH LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4465
Mailing Address - Country:US
Mailing Address - Phone:956-212-4312
Mailing Address - Fax:
Practice Address - Street 1:123 W MILE 3 RD
Practice Address - Street 2:SUITE A-103
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-1633
Practice Address - Country:US
Practice Address - Phone:956-585-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116544225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics