Provider Demographics
NPI:1659046316
Name:RIVERA, LAURA LUCIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LUCIA
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 1:803 WEST 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801
Mailing Address - Country:US
Mailing Address - Phone:870-826-3820
Mailing Address - Fax:
Practice Address - Street 1:7777 HIGHWAY 67S
Practice Address - Street 2:GURDON PUBLIC SCHOOL
Practice Address - City:GURDON
Practice Address - State:AR
Practice Address - Zip Code:71743
Practice Address - Country:US
Practice Address - Phone:870-353-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1720224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant