Provider Demographics
NPI:1457190274
Name:RIVERA RIVERA, ZORY M
Entity type:Individual
Prefix:
First Name:ZORY
Middle Name:M
Last Name:RIVERA RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 METZ LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3466
Mailing Address - Country:US
Mailing Address - Phone:407-731-3844
Mailing Address - Fax:
Practice Address - Street 1:1200 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4450
Practice Address - Country:US
Practice Address - Phone:407-530-5063
Practice Address - Fax:877-399-5578
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency