Provider Demographics
NPI:1750889739
Name:RIVERA VISALDEN, CARMEN MILAGROS (OTR/L)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MILAGROS
Last Name:RIVERA VISALDEN
Suffix:
Gender:F
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 1:419 ALMENDRO
Mailing Address - Street 2:HACIENDA BORINQUEN
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-635-4243
Mailing Address - Fax:
Practice Address - Street 1:139 CALLE CAYEY
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-4902
Practice Address - Country:US
Practice Address - Phone:787-600-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR511225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR511OtherLIC.