Provider Demographics
NPI:1588752596
Name:ANTONE, ROCIO G (OTR)
Entity type:Individual
Prefix:MRS
First Name:ROCIO
Middle Name:G
Last Name:ANTONE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:ROCIO
Other - Middle Name:L
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3110 SEAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2448
Mailing Address - Country:US
Mailing Address - Phone:361-854-9741
Mailing Address - Fax:361-854-9742
Practice Address - Street 1:3462 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1720
Practice Address - Country:US
Practice Address - Phone:361-854-9741
Practice Address - Fax:361-854-9742
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612738Medicare PIN