Provider Demographics
NPI:1265188205
Name:RIOS-VEGA, LADY JULIETH (OTD)
Entity type:Individual
Prefix:
First Name:LADY
Middle Name:JULIETH
Last Name:RIOS-VEGA
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-7114
Mailing Address - Country:US
Mailing Address - Phone:856-889-4683
Mailing Address - Fax:
Practice Address - Street 1:2080 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-7114
Practice Address - Country:US
Practice Address - Phone:856-889-4683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist