Provider Demographics
NPI:1114516085
Name:RILEY, CHERIE ANN (LPMT-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPMT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 BRIARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-9552
Mailing Address - Country:US
Mailing Address - Phone:417-499-6266
Mailing Address - Fax:
Practice Address - Street 1:10025 S 705 RD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:OK
Practice Address - Zip Code:74370-9507
Practice Address - Country:US
Practice Address - Phone:918-303-5433
Practice Address - Fax:918-615-9666
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OK40225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No175T00000XOther Service ProvidersPeer Specialist