Provider Demographics
NPI:1164057428
Name:RILEY, ERIC (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2117
Mailing Address - Country:US
Mailing Address - Phone:304-523-1164
Mailing Address - Fax:304-522-2474
Practice Address - Street 1:803 7TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2117
Practice Address - Country:US
Practice Address - Phone:304-523-1164
Practice Address - Fax:304-522-2474
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist