Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31006390A | IN |
N | 2251E1200X | Ergonomics | 31006390A | IN |
N | 225XE1200X | Ergonomics | 31006390A | IN |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31006390A | IN |
NPI | 1396256053 |
---|---|
Provider Name | Andrew David Rivera |
First Address | Fort Wayne, IN 46835-9213 |
Second Address | Albion, IN 46701-1541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2017 |
Last Update Date | 19/10/2017 |