Provider Demographics
NPI:1215646831
Name:WARE, RIA NALINI (OTR/L)
Entity type:Individual
Prefix:
First Name:RIA
Middle Name:NALINI
Last Name:WARE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13756 SANDY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2255
Mailing Address - Country:US
Mailing Address - Phone:904-504-0692
Mailing Address - Fax:
Practice Address - Street 1:4600 MIDDLETON PARK CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5691
Practice Address - Country:US
Practice Address - Phone:904-507-4962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL007417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist