Healthcare Provider Details

I. General information

NPI: 1962928572
Provider Name (Legal Business Name): FELIPE RIVERA OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PERALTA RD
PERALTA NM
87042-8856
US

IV. Provider business mailing address

13 PERALTA RD
PERALTA NM
87042-8856
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-8226
  • Fax: 505-213-8559
Mailing address:
  • Phone: 505-249-8226
  • Fax: 505-213-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2182
License Number StateNM

VIII. Authorized Official

Name: MR. FELIPE FERMIN RIVERA
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT/L
Phone: 505-249-8226