Provider Demographics
NPI:1356915995
Name:ROSA-RIVERA, LISSETTE (MS, OT/L)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:ROSA-RIVERA
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 CALLE PABLO IGLESIAS
Mailing Address - Street 2:URB. PALACIOS DE MARBELLA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-316-1384
Mailing Address - Fax:
Practice Address - Street 1:1129 CALLE PABLO IGLESIAS
Practice Address - Street 2:URB. PALACIOS DE MARBELLA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-316-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1095225XN1300X, 225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation