Provider Demographics
NPI:1720104730
Name:YU, SIR AVILIN RIVERA (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:SIR AVILIN
Middle Name:RIVERA
Last Name:YU
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S KNOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1406
Mailing Address - Country:US
Mailing Address - Phone:714-821-7310
Mailing Address - Fax:714-220-9556
Practice Address - Street 1:141 S KNOTT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1406
Practice Address - Country:US
Practice Address - Phone:714-821-7310
Practice Address - Fax:714-220-9556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist