Provider Demographics
NPI:1770117897
Name:RIVAS-GARCIA, JENNIFER LETICIA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LETICIA
Last Name:RIVAS-GARCIA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9871 MARIPOSA LILY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1435
Mailing Address - Country:US
Mailing Address - Phone:702-343-2093
Mailing Address - Fax:
Practice Address - Street 1:9871 MARIPOSA LILY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1435
Practice Address - Country:US
Practice Address - Phone:702-343-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2370225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics