Provider Demographics
NPI:1063541357
Name:RODRIGUEZ, CARMEN E (COTA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:ENID
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOPEZ, MERCADO
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:610-991-2034
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:11509 PINELOCH LOOP
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:863-205-7585
Practice Address - Fax:610-438-2046
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684531Medicare Oscar/Certification