Provider Demographics
NPI:1326537960
Name:RIVERA, MARIA DEL MAR (OT)
Entity Type:Individual
Prefix:
First Name:MARIA DEL MAR
Middle Name:
Last Name:RIVERA
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 1:3119 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5632
Mailing Address - Country:US
Mailing Address - Phone:813-662-1106
Mailing Address - Fax:813-661-7661
Practice Address - Street 1:3119 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5632
Practice Address - Country:US
Practice Address - Phone:813-662-1106
Practice Address - Fax:813-661-7661
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist