Provider Demographics
NPI:1700386349
Name:RIVERA, NANCY JEANNE (OTR)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEANNE
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 1:311 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:TX
Mailing Address - Zip Code:75173-0122
Mailing Address - Country:US
Mailing Address - Phone:631-523-3039
Mailing Address - Fax:
Practice Address - Street 1:18 SAN JUAN CIR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8215
Practice Address - Country:US
Practice Address - Phone:631-523-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist