Healthcare Provider Details

I. General information

NPI: 1538470638
Provider Name (Legal Business Name): CHRISTOPHER PATRICK RIVARD OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ORLEANS STREET
BEAUMONT TX
77701-3308
US

IV. Provider business mailing address

2485 S MAJOR DR 625 ORLEANS STREET
BEAUMONT TX
77707-5019
US

V. Phone/Fax

Practice location:
  • Phone: 713-805-4095
  • Fax:
Mailing address:
  • Phone: 409-861-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number113225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: