Individual
LISA ANN RODRIQUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
45 MERIDEN AVE, SOUTHINGTON, CT 06489-3214
(860) 378-1234
(860) 378-1160
Mailing address
56 FOXCROFT CT, SOUTHINGTON, CT 06489-4341
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
000394
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11244279
CAQH
CT
01
—
130000394CT01
BCBS
CT
Enumeration date
03/29/2007
Last updated
07/08/2007
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