Provider Demographics
NPI:1518562420
Name:RILEY, WILLETTE (MA)
Entity Type:Individual
Prefix:MS
First Name:WILLETTE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5714
Mailing Address - Country:US
Mailing Address - Phone:330-338-6332
Mailing Address - Fax:234-334-5404
Practice Address - Street 1:1472 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5714
Practice Address - Country:US
Practice Address - Phone:330-338-6332
Practice Address - Fax:234-334-5404
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251X00000XAgenciesSupports Brokerage
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker