Provider Demographics
NPI:1073615035
Name:RIVA, DIANA MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:RIVA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:22939 COLLRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4077
Mailing Address - Country:US
Mailing Address - Phone:954-684-6827
Mailing Address - Fax:
Practice Address - Street 1:206 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4617
Practice Address - Country:US
Practice Address - Phone:813-662-1060
Practice Address - Fax:813-662-0530
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12240225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics