Provider Demographics
NPI:1346483161
Name:RYLEY, ROBERT M (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:RYLEY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 S WILLOW ST STE 166
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5751
Mailing Address - Country:US
Mailing Address - Phone:603-820-4458
Mailing Address - Fax:877-284-8192
Practice Address - Street 1:373 S WILLOW ST STE 166
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5751
Practice Address - Country:US
Practice Address - Phone:603-820-4458
Practice Address - Fax:877-284-8192
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00033400225X00000X
NY010183225X00000X
NH2867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist