Provider Demographics
NPI:1154612786
Name:RITVO, SKYLRE ARIEL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SKYLRE
Middle Name:ARIEL
Last Name:RITVO
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 1:1519 S FAIRFAX AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4908
Mailing Address - Country:US
Mailing Address - Phone:617-283-5910
Mailing Address - Fax:
Practice Address - Street 1:822 S ROBERTSON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1613
Practice Address - Country:US
Practice Address - Phone:310-365-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA14056225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program