Provider Demographics
NPI:1790091163
Name:RILEY, AUBRIE
Entity Type:Individual
Prefix:
First Name:AUBRIE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 E TYLER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7211
Mailing Address - Country:US
Mailing Address - Phone:956-440-0580
Mailing Address - Fax:956-440-0584
Practice Address - Street 1:2117 E TYLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7211
Practice Address - Country:US
Practice Address - Phone:956-440-0580
Practice Address - Fax:956-440-0584
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA-0000400224Z00000X
TX210900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210900OtherSTATE LICENSE