Provider Demographics
NPI:1669351425
Name:RIVERA BURGOS, GLORYMAR (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:GLORYMAR
Middle Name:
Last Name:RIVERA BURGOS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB GRAN VISTA 32
Mailing Address - Street 2:CALLE VALLE SUR
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1111
Mailing Address - Country:US
Mailing Address - Phone:787-402-0350
Mailing Address - Fax:
Practice Address - Street 1:CARR 1 PARQUE INDUSTRIAL VILLA BLANCA
Practice Address - Street 2:EDIFICIO PLAZA BAIROA LOCAL 135
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1111
Practice Address - Country:US
Practice Address - Phone:787-407-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist