Provider Demographics
NPI:1033412929
Name:RIVERA, GRIMALDI (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:GRIMALDI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8896 NW 108TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4525
Mailing Address - Country:US
Mailing Address - Phone:786-262-6445
Mailing Address - Fax:
Practice Address - Street 1:3232 W ROYAL LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3105
Practice Address - Country:US
Practice Address - Phone:877-453-5162
Practice Address - Fax:972-983-0292
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 14306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist