MEDICARE: MRS. SOCORRO RIVERA T.O.

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	455	PR

General Provider Information

NPI Number	:	1922217017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOCORRO RIVERA T.O.

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739
Country	:	US
Telephone Number	:	787-739-1256
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 CALLE AQUAMARINA
Second Line	:	VILLA BLANCA
City	:	CAGUAS
State	:	PR
Zip	:	00725-1908
Country	:	US
Telephone Number	:	787-743-1047
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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