Provider Demographics
NPI:1023746716
Name:RIVEROS, MILTON DAVID (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:DAVID
Last Name:RIVEROS
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2024
Mailing Address - Country:US
Mailing Address - Phone:860-422-0568
Mailing Address - Fax:
Practice Address - Street 1:54 WILSON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2024
Practice Address - Country:US
Practice Address - Phone:860-422-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025240-01225X00000X
PAOC14995225X00000X
SC5946225X00000X
COOT.0006631225X00000X
CT48.004623225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist