Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT12240 | FL |
NPI | 1073615035 |
---|---|
Provider Name | Diana Marie Riva |
First Address | Land O Lakes, FL 34639-4077 |
Second Address | Brandon, FL 33510-4617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 16/03/2011 |