Provider Demographics
NPI:1932432101
Name:RIEGER, VIRGINIA J
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:J
Last Name:RIEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:J
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:727 E BRUNDAGE LN STE L
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6280
Mailing Address - Country:US
Mailing Address - Phone:307-683-0123
Mailing Address - Fax:307-683-0101
Practice Address - Street 1:727 E BRUNDAGE LN STE L
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6280
Practice Address - Country:US
Practice Address - Phone:307-683-0123
Practice Address - Fax:307-683-0101
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY128519000Medicaid
WYW22923Medicare UPIN