Individual
BRANDON LEE RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
408 IRONSIDE TRAIL DR, GROVELAND, FL 34736-8255
(407) 529-4651
Mailing address
408 IRONSIDE TRAIL DR, GROVELAND, FL 34736-8255
(407) 529-4651
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT18641
FL
Other
Enumeration date
09/06/2020
Last updated
09/06/2020
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