Provider Demographics
NPI:1073964680
Name:MORCIGLIO RIVERA, NICOLE MARIE (ATO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:MORCIGLIO RIVERA
Suffix:
Gender:F
Credentials:ATO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 83630
Mailing Address - Street 2:CARR 119 KM 28.4 BO HOYAMALA
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-8706
Mailing Address - Country:US
Mailing Address - Phone:787-597-5547
Mailing Address - Fax:
Practice Address - Street 1:HC 8 BOX 83630
Practice Address - Street 2:CARR 119 KM 28.4 BO HOYAMALA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-8706
Practice Address - Country:US
Practice Address - Phone:787-597-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1039224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant