Provider Demographics
NPI:1780832196
Name:RIELLY, HELENE (COTA)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:
Last Name:RIELLY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 STONE SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-3013
Mailing Address - Country:US
Mailing Address - Phone:845-733-2785
Mailing Address - Fax:
Practice Address - Street 1:325 STONE SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721-3013
Practice Address - Country:US
Practice Address - Phone:845-733-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004852-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant