MEDICARE: KADESHIA RIBEIRO

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	225XN1300X	Neurorehabilitation Occupational Therapist	122290	TX
2	225XP0019X	Physical Rehabilitation Occupational Therapist	122290	TX
3	225X00000X	Occupational Therapist	122290	TX

General Provider Information

NPI Number	:	1972394815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KADESHIA RIBEIRO

Provider Business Mailing Address
First Line	:	7827 FRENCH MARIGOLD LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-1654
Country	:	US
Telephone Number	:	609-251-8907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 SWISS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6224
Country	:	US
Telephone Number	:	214-820-9700
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ KADESHIA RIBEIRO ” Practice Location

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