Provider Demographics
NPI:1003340944
Name:RILEY, HOLLYANN ELISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:HOLLYANN
Middle Name:ELISE
Last Name:RILEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HOLLYANN
Other - Middle Name:ELISE
Other - Last Name:KABBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5930 ADOBE RD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2356
Mailing Address - Country:US
Mailing Address - Phone:760-367-1743
Mailing Address - Fax:
Practice Address - Street 1:5930 ADOBE RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2356
Practice Address - Country:US
Practice Address - Phone:760-367-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist