Provider Demographics
NPI:1487196143
Name:RIFFEL, VIVIAN JEAN
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JEAN
Last Name:RIFFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:JEAN
Other - Last Name:MAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:6821 STATE ROUTE 522
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-8960
Mailing Address - Country:US
Mailing Address - Phone:740-574-8969
Mailing Address - Fax:
Practice Address - Street 1:6821 STATE ROUTE 522
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8960
Practice Address - Country:US
Practice Address - Phone:740-574-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171387224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant