Provider Demographics
NPI:1407450679
Name:HASENOUR, RILEY JANE (OTR)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:JANE
Last Name:HASENOUR
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 1:1956 S 1025 E # R
Mailing Address - Street 2:
Mailing Address - City:BIRDSEYE
Mailing Address - State:IN
Mailing Address - Zip Code:47513-9419
Mailing Address - Country:US
Mailing Address - Phone:812-639-0676
Mailing Address - Fax:
Practice Address - Street 1:1956 S 1025 E # R
Practice Address - Street 2:
Practice Address - City:BIRDSEYE
Practice Address - State:IN
Practice Address - Zip Code:47513-9419
Practice Address - Country:US
Practice Address - Phone:812-639-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INUNKNOWNMedicaid