Provider Demographics
NPI:1477947752
Name:RIVAS, MARY ANN JESSAH
Entity Type:Individual
Prefix:MISS
First Name:MARY ANN JESSAH
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 LAKEVIEW DR APT 82
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7927
Mailing Address - Country:US
Mailing Address - Phone:561-886-8710
Mailing Address - Fax:
Practice Address - Street 1:3210 LAKEVIEW DR APT 82
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7927
Practice Address - Country:US
Practice Address - Phone:561-886-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist