Basic Information
| Provider Information | |||||||||
| NPI: | 1669870531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUES | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 COLE RD | ||||||||
| Address2: | PO BOX 113 | ||||||||
| City: | RED OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751544802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147694720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 NE LOOP 820 | ||||||||
| Address2: | BUSINESS TOWER1, SUITE 200 | ||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760537209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172928787 | ||||||||
| FaxNumber: | 8177896849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2014 | ||||||||
| LastUpdateDate: | 12/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 101960 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.