MEDICARE: YARITZA RIVERA AVILES OTL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	924	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	924	OTHER	PR	OCCUPATIONAL THERAPIST LICENCE

General Provider Information

NPI Number	:	1093952368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YARITZA RIVERA AVILES OTL

Provider Business Mailing Address
First Line	:	CONDOMINIO PARQUE DEL LAGO
Second Line	:	100 CALLE 13 BUZON 406
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3239
Country	:	US
Telephone Number	:	787-923-2408
Fax Number	:	939-336-5897

Provider Business Practice Location Address
First Line	:	CONDOMINIO PARQUE DEL LAGO
Second Line	:	100 CALLE 13 BOX 406
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3239
Country	:	US
Telephone Number	:	787-923-2408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	08/08/2016

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