Provider Demographics
NPI:1467985531
Name:BOYLE, RILEY (OT)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1210
Mailing Address - Country:US
Mailing Address - Phone:207-735-6502
Mailing Address - Fax:
Practice Address - Street 1:103 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4324
Practice Address - Country:US
Practice Address - Phone:207-947-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist