Provider Demographics
NPI:1730337973
Name:RODRIGUEZ, DIANE DENISE (OTR)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:DENISE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:DENISE
Other - Last Name:HAYASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1920 N ZARAGOZA RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4655
Mailing Address - Country:US
Mailing Address - Phone:915-276-8700
Mailing Address - Fax:800-971-7978
Practice Address - Street 1:1920 N ZARAGOZA RD
Practice Address - Street 2:SUITE 108
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4655
Practice Address - Country:US
Practice Address - Phone:915-276-8700
Practice Address - Fax:800-971-7978
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109054225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3228066Medicaid