Provider Demographics
NPI:1962928572
Name:FELIPE RIVERA OCCUPATIONAL THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:FELIPE RIVERA OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:FERMIN
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MOT/L
Authorized Official - Phone:505-249-8226
Mailing Address - Street 1:13 PERALTA RD
Mailing Address - Street 2:
Mailing Address - City:PERALTA
Mailing Address - State:NM
Mailing Address - Zip Code:87042-8856
Mailing Address - Country:US
Mailing Address - Phone:505-249-8226
Mailing Address - Fax:505-213-8559
Practice Address - Street 1:13 PERALTA RD
Practice Address - Street 2:
Practice Address - City:PERALTA
Practice Address - State:NM
Practice Address - Zip Code:87042-8856
Practice Address - Country:US
Practice Address - Phone:505-249-8226
Practice Address - Fax:505-213-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1548717820Medicaid
NM1902331754Medicaid