Provider Demographics
NPI:1982571139
Name:RILEY, JAMES (MM, MT-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6105
Mailing Address - Country:US
Mailing Address - Phone:305-304-4497
Mailing Address - Fax:
Practice Address - Street 1:4144 5TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6304
Practice Address - Country:US
Practice Address - Phone:727-350-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist