Provider Demographics
NPI:1194386623
Name:RILEY, KALLIHAN MARY HANNAH (OTD)
Entity Type:Individual
Prefix:
First Name:KALLIHAN
Middle Name:MARY HANNAH
Last Name:RILEY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1760
Mailing Address - Country:US
Mailing Address - Phone:815-209-7917
Mailing Address - Fax:
Practice Address - Street 1:502 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1760
Practice Address - Country:US
Practice Address - Phone:815-209-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019038039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist