Individual
NICHOLAS RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
334 STAFFORD WAY, BOLINGBROOK, IL 60440-2128
(630) 484-1113
Mailing address
334 STAFFORD WAY, BOLINGBROOK, IL 60440-2128
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056011717
IL
Other
Enumeration date
12/10/2016
Last updated
12/10/2016
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