Individual
COLLEEN RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20720 LAKE RIDGE DR, PRIOR LAKE, MN 55372-8808
(612) 817-4441
Mailing address
20720 LAKE RIDGE DR, PRIOR LAKE, MN 55372-8808
(612) 817-4441
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
101407
MN
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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