Healthcare Provider Details

I. General information

NPI: 1497884829
Provider Name (Legal Business Name): JILL DEBORAH RIVES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22402 CAROLINE CHASE CT
KATY TX
77494-2220
US

IV. Provider business mailing address

22402 CAROLINE CHASE CT
KATY TX
77494-2220
US

V. Phone/Fax

Practice location:
  • Phone: 281-395-5963
  • Fax:
Mailing address:
  • Phone: 281-395-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number110304
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number110304
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number110304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: