Provider Demographics
NPI:1588906374
Name:RIVERA, ADRIEL DAVID (OTR)
Entity type:Individual
Prefix:
First Name:ADRIEL
Middle Name:DAVID
Last Name:RIVERA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373
Mailing Address - Country:US
Mailing Address - Phone:318-201-1599
Mailing Address - Fax:
Practice Address - Street 1:7442 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7018
Practice Address - Country:US
Practice Address - Phone:330-477-9720
Practice Address - Fax:330-491-2049
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13268225X00000X
OHOT010380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist