MEDICARE: MIGDALIS ADIANEZ RIVERA OTR

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	225X00000X	Occupational Therapist	OT14248	FL

General Provider Information

NPI Number	:	1700189586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGDALIS ADIANEZ RIVERA OTR

Provider Business Mailing Address
First Line	:	6218 IROQUOIS CT
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3322
Country	:	US
Telephone Number	:	813-926-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 CONGRESS ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-3909
Country	:	US
Telephone Number	:	727-264-8819
Fax Number	:

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

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	12/16/2010

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