Provider Demographics
NPI:1003217720
Name:RILEY, KATHLEEN (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 WHITE ASH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1558
Mailing Address - Country:US
Mailing Address - Phone:614-596-3073
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-2105
Practice Address - Country:US
Practice Address - Phone:937-578-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 002317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist