Provider Demographics
NPI:1851328397
Name:OTT RIVERA, MICHELLE PATRICE (MS, RD, CDE, LD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:PATRICE
Last Name:OTT RIVERA
Suffix:
Gender:F
Credentials:MS, RD, CDE, LD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:OTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:15655 CYPRESS WOOD MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1487
Practice Address - Country:US
Practice Address - Phone:713-442-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06278133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61046Medicare ID - Type UnspecifiedGROUP NUMBER