Provider Demographics
NPI:1700189586
Name:RIVERA, MIGDALIS ADIANEZ (OTR)
Entity Type:Individual
Prefix:
First Name:MIGDALIS
Middle Name:ADIANEZ
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 1:6218 IROQUOIS CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3322
Mailing Address - Country:US
Mailing Address - Phone:813-926-9151
Mailing Address - Fax:
Practice Address - Street 1:6120 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3909
Practice Address - Country:US
Practice Address - Phone:727-264-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist