Provider Demographics
NPI:1295372506
Name:SMETZLER, RILEY N
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:N
Last Name:SMETZLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRIANGLE SHOPPING CTR STE 270
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4684
Mailing Address - Country:US
Mailing Address - Phone:360-501-3750
Mailing Address - Fax:
Practice Address - Street 1:200 TRIANGLE SHOPPING CTR STE 270
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4684
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2023-03-13
Deactivation Date:2023-01-03
Deactivation Code:
Reactivation Date:2023-03-13
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician