Provider Demographics
NPI:1154625119
Name:RIVERA, PIETRA ELIZABETH (OT)
Entity type:Individual
Prefix:MRS
First Name:PIETRA
Middle Name:ELIZABETH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ENTWISTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1906
Mailing Address - Country:US
Mailing Address - Phone:516-712-7500
Mailing Address - Fax:
Practice Address - Street 1:3830 PAULDING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1220
Practice Address - Country:US
Practice Address - Phone:718-882-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013468-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor