MEDICARE: JENNIFER LETICIA RIVAS-GARCIA M.S., OTR/L

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	OT-2370	NV
2	225X00000X	Occupational Therapist	OT-2370	NV

General Provider Information

NPI Number	:	1770117897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LETICIA RIVAS-GARCIA M.S., OTR/L

Provider Business Mailing Address
First Line	:	9871 MARIPOSA LILY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1435
Country	:	US
Telephone Number	:	702-343-2093
Fax Number	:

Provider Business Practice Location Address
First Line	:	9871 MARIPOSA LILY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1435
Country	:	US
Telephone Number	:	702-343-2093
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	12/04/2024

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