Provider Demographics
NPI:1336284330
Name:RIVERA, ALICIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 78TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7981
Mailing Address - Country:US
Mailing Address - Phone:941-545-9057
Mailing Address - Fax:941-739-7162
Practice Address - Street 1:4808 78TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7981
Practice Address - Country:US
Practice Address - Phone:941-545-9057
Practice Address - Fax:941-739-7162
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7054225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0994AMedicare ID - Type UnspecifiedPROVIDER NUMBER