Provider Demographics
NPI:1750959409
Name:FIKES, RYLIE MAY (OTD)
Entity type:Individual
Prefix:DR
First Name:RYLIE
Middle Name:MAY
Last Name:FIKES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SW VALERIA VIEW DR APT 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-7089
Mailing Address - Country:US
Mailing Address - Phone:408-722-8247
Mailing Address - Fax:
Practice Address - Street 1:470 SW VALERIA VIEW DR APT 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-7089
Practice Address - Country:US
Practice Address - Phone:408-722-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR455126225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist