Provider Demographics
NPI:1063053460
Name:RODRIGUEZ, STEPHEN RENEE (OTR)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RENEE
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 1:2837 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1572
Mailing Address - Country:US
Mailing Address - Phone:832-527-2558
Mailing Address - Fax:
Practice Address - Street 1:2837 CHELSEA LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1572
Practice Address - Country:US
Practice Address - Phone:832-527-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist