Provider Demographics
NPI:1407453905
Name:RIVERA OT, INC
Entity type:Organization
Organization Name:RIVERA OT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:754-610-8381
Mailing Address - Street 1:7199 NW 47TH PL
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3409
Mailing Address - Country:US
Mailing Address - Phone:754-610-8381
Mailing Address - Fax:
Practice Address - Street 1:7199 NW 47TH PL
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-3409
Practice Address - Country:US
Practice Address - Phone:754-610-8381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center