Healthcare Provider Details

I. General information

NPI: 1972993368
Provider Name (Legal Business Name): MARIEL NUNEZ RIVERA OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE AUTONOMIA, ESQ CALLE BETANCES NUM. PBO 5 EDF MULTIUSOS
CANOVANAS PR
00729-9998
US

IV. Provider business mailing address

55 CALLE GUARAGUAO URB LOS ARBOLES
RIO GRANDE PR
00745-5306
US

V. Phone/Fax

Practice location:
  • Phone: 939-539-5423
  • Fax:
Mailing address:
  • Phone: 939-539-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number941
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: