Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1095 | PR |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1095 | PR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1095 | PR |
NPI | 1356915995 |
---|---|
Provider Name | Mrs. Lissette Rosa-Rivera |
First Address | Toa Alta, PR 00953 |
Second Address | Toa Alta, PR 00953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2021 |
Last Update Date | 18/05/2021 |