Provider Demographics
NPI:1811686397
Name:RILEY, SHIELA ANN
Entity type:Individual
Prefix:
First Name:SHIELA
Middle Name:ANN
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 1:411 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MILLBORO
Mailing Address - State:VA
Mailing Address - Zip Code:24460-2132
Mailing Address - Country:US
Mailing Address - Phone:540-997-5452
Mailing Address - Fax:540-997-0123
Practice Address - Street 1:411 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MILLBORO
Practice Address - State:VA
Practice Address - Zip Code:24460-2132
Practice Address - Country:US
Practice Address - Phone:540-997-5452
Practice Address - Fax:540-997-0123
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000176225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist