Provider Demographics
NPI:1194975870
Name:FUENTES, MONICA RODRIGUEZ (OTR)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:RODRIGUEZ
Last Name:FUENTES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 PASEO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-4346
Mailing Address - Country:US
Mailing Address - Phone:512-280-8522
Mailing Address - Fax:512-280-8522
Practice Address - Street 1:4111 PASEO DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-4346
Practice Address - Country:US
Practice Address - Phone:512-280-8522
Practice Address - Fax:512-280-8522
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist