Provider Demographics
NPI:1689817801
Name:PIELAGO, RIZZA MAE BALDEVIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RIZZA MAE
Middle Name:BALDEVIA
Last Name:PIELAGO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BROADLYN CT
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1401
Mailing Address - Country:US
Mailing Address - Phone:845-215-9247
Mailing Address - Fax:
Practice Address - Street 1:10 BROADLYN COURT
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1401
Practice Address - Country:US
Practice Address - Phone:845-215-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist