Provider Demographics
NPI:1326527698
Name:RIVERA, JESSICA MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Mailing Address - Street 2:2238 E. GINTER ROAD
Mailing Address - City:TUSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706
Mailing Address - Country:US
Mailing Address - Phone:520-545-2137
Mailing Address - Fax:520-545-3416
Practice Address - Street 1:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Practice Address - Street 2:2238 E. GINTER ROAD
Practice Address - City:TUSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-545-2137
Practice Address - Fax:520-545-3416
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTA-046618OtherOCCUPA THERAPY ASST