Provider Demographics
NPI:1194956805
Name:RIVERA-ROHENA, MARIELY (ITDS)
Entity type:Individual
Prefix:MS
First Name:MARIELY
Middle Name:
Last Name:RIVERA-ROHENA
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 N WILDER RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-2330
Mailing Address - Country:US
Mailing Address - Phone:863-412-6929
Mailing Address - Fax:863-299-9239
Practice Address - Street 1:4224 N WILDER RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33565-2330
Practice Address - Country:US
Practice Address - Phone:863-412-6929
Practice Address - Fax:863-299-9239
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist