Provider Demographics
NPI:1831599398
Name:RIVERA, TAYLOR (ATC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W LAKEWOOD ST
Mailing Address - Street 2:APT 206A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1867
Mailing Address - Country:US
Mailing Address - Phone:417-988-4022
Mailing Address - Fax:
Practice Address - Street 1:220 W LAKEWOOD ST
Practice Address - Street 2:APT 206A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1867
Practice Address - Country:US
Practice Address - Phone:417-988-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer