MEDICARE: AMYLEE ANN 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	106S00000X	Behavior Technician
2	2355S0801X	Speech-Language Assistant	7089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639662828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMYLEE ANN RIVERA

Provider Business Mailing Address
First Line	:	332 CAEN CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-3446
Country	:	US
Telephone Number	:	689-280-1013
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S WEST CROWN POINT RD
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2916
Country	:	US
Telephone Number	:	407-905-8908
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	08/28/2024

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Directions to “ AMYLEE ANN RIVERA ” Practice Location

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