Provider Demographics
NPI:1093952368
Name:RIVERA AVILES, YARITZA (OTL)
Entity Type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:RIVERA AVILES
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO PARQUE DEL LAGO
Mailing Address - Street 2:100 CALLE 13 BUZON 406
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3239
Mailing Address - Country:US
Mailing Address - Phone:787-923-2408
Mailing Address - Fax:939-336-5897
Practice Address - Street 1:CONDOMINIO PARQUE DEL LAGO
Practice Address - Street 2:100 CALLE 13 BOX 406
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3239
Practice Address - Country:US
Practice Address - Phone:787-923-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR924225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR924OtherOCCUPATIONAL THERAPIST LICENCE