Provider Demographics
NPI:1215190285
Name:RIPLEY, MYRA D (OTR)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:D
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 PEACE LN
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-9559
Mailing Address - Country:US
Mailing Address - Phone:847-224-9797
Mailing Address - Fax:847-327-1551
Practice Address - Street 1:3905 PEACE LN
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-9559
Practice Address - Country:US
Practice Address - Phone:847-224-9797
Practice Address - Fax:847-327-1551
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.001767225X00000X
WI3563-026225X00000X
OHOT.003218225X00000X
IN31001591A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist