MEDICARE: YESENIA RIVERA OTR L

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	056.007511	IL

General Provider Information

NPI Number	:	1831246560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESENIA RIVERA OTR L

Provider Business Mailing Address
First Line	:	1129 N HOMAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4008
Country	:	US
Telephone Number	:	773-351-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 N HOMAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4008
Country	:	US
Telephone Number	:	773-351-2902
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	01/24/2012

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Directions to “ YESENIA RIVERA OTR L” Practice Location

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