Provider Demographics
NPI:1598263550
Name:RILEY, THOMAS C (OT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:RILEY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20012 N SABINO LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-7200
Mailing Address - Country:US
Mailing Address - Phone:623-734-5200
Mailing Address - Fax:
Practice Address - Street 1:14418 W MEEKER BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5292
Practice Address - Country:US
Practice Address - Phone:623-524-4038
Practice Address - Fax:623-524-6674
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist