Provider Demographics
NPI:1164648978
Name:RIVIELLO, JULIE ANN (OT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:RIVIELLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-2477
Mailing Address - Country:US
Mailing Address - Phone:267-879-3642
Mailing Address - Fax:
Practice Address - Street 1:2716 ORTHODOX ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1604
Practice Address - Country:US
Practice Address - Phone:215-743-4435
Practice Address - Fax:215-743-8848
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007063L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096640PQXMedicare ID - Type Unspecified