Provider Demographics
NPI:1225206634
Name:RIVERA, DALIS M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DALIS
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:DALIS
Other - Middle Name:MINEIRA
Other - Last Name:DONIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10621 WITTENBERG WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7028
Mailing Address - Country:US
Mailing Address - Phone:321-354-6571
Mailing Address - Fax:321-354-6571
Practice Address - Street 1:10621 WITTENBERG WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7028
Practice Address - Country:US
Practice Address - Phone:321-354-6571
Practice Address - Fax:321-354-6571
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 1601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist