Provider Demographics
NPI:1154106599
Name:RIVAS, PRISCILLA CHARYSSE (COTA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:CHARYSSE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 SW 15TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4047
Mailing Address - Country:US
Mailing Address - Phone:786-439-6868
Mailing Address - Fax:
Practice Address - Street 1:1441 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2202
Practice Address - Country:US
Practice Address - Phone:305-541-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA19589224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant