Provider Demographics
NPI:1396971503
Name:VICTORIANO, HECTOR RIVERA (OTR/L)
Entity type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:RIVERA
Last Name:VICTORIANO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:HECTOR POCHOLO
Other - Middle Name:RIVERA
Other - Last Name:VICTORIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:170 HALPIN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1227
Mailing Address - Country:US
Mailing Address - Phone:718-820-2239
Mailing Address - Fax:
Practice Address - Street 1:170 HALPIN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1227
Practice Address - Country:US
Practice Address - Phone:718-820-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist