Provider Demographics
NPI:1346563806
Name:RIVERA, BOBBI-JO (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:BOBBI-JO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:BOBBI-JO
Other - Middle Name:
Other - Last Name:CRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:THE PARENTING PLACE
Mailing Address - Street 2:1500 GREEN BAY STREET
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6455
Mailing Address - Country:US
Mailing Address - Phone:608-784-8125
Mailing Address - Fax:608-796-0098
Practice Address - Street 1:THE PARENTING PLACE
Practice Address - Street 2:1500 GREEN BAY STREET
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6455
Practice Address - Country:US
Practice Address - Phone:608-784-8125
Practice Address - Fax:608-796-0098
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103980225X00000X
WI4857-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
MNENROLLEDMedicaid
MNENROLLEDMedicaid
MN670000727Medicare PIN