Healthcare Provider Details

I. General information

NPI: 1093621641
Provider Name (Legal Business Name): YVETTE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 MANTOVA DR
CLAY NY
13041-9112
US

IV. Provider business mailing address

8212 MANTOVA DR
CLAY NY
13041-9112
US

V. Phone/Fax

Practice location:
  • Phone: 315-720-9607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number010758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: