Provider Demographics
NPI:1699230797
Name:RODRIGUEZ, CAROL E
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 LEAVITT ST APT 202
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-6550
Mailing Address - Country:US
Mailing Address - Phone:781-824-0686
Mailing Address - Fax:
Practice Address - Street 1:47 LEAVITT ST APT 202
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-6550
Practice Address - Country:US
Practice Address - Phone:781-824-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14144225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist