Provider Demographics
NPI:1841442050
Name:RODRIGUEZ, GLADYS J (OTRL)
Entity type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3777 INDEPENDENCE AVE
Mailing Address - Street 2:APT. 16A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1409
Mailing Address - Country:US
Mailing Address - Phone:718-796-7614
Mailing Address - Fax:718-601-7422
Practice Address - Street 1:3777 INDEPENDENCE AVE
Practice Address - Street 2:APT. 16A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1409
Practice Address - Country:US
Practice Address - Phone:718-796-7614
Practice Address - Fax:718-601-7422
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004859-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist