Provider Demographics
NPI:1376934786
Name:RIVERA, ANN MARIE (LAC, LOTA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LAC, LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR # 21404
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:214-394-0128
Mailing Address - Fax:
Practice Address - Street 1:1816 N HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2731
Practice Address - Country:US
Practice Address - Phone:214-394-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-07
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01553171100000X
TX208552224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No171100000XOther Service ProvidersAcupuncturist