MEDICARE: TILSA A. RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	599	PR

General Provider Information

NPI Number	:	1174490809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TILSA A. RIVERA

Provider Business Mailing Address
First Line	:	SUMMIT # 610
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3072
Country	:	US
Telephone Number	:	787-517-6383
Fax Number	:

Provider Business Practice Location Address
First Line	:	SUMMIT # 610
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3072
Country	:	US
Telephone Number	:	787-517-6383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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Directions to “ TILSA A. RIVERA ” Practice Location

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