MEDICARE: KATHERINE A RIDDLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0T010118	OH

General Provider Information

NPI Number	:	1265286603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE A RIDDLE

Provider Business Mailing Address
First Line	:	705 BROAD BLVD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-1907
Country	:	US
Telephone Number	:	937-726-4335
Fax Number	:

Provider Business Practice Location Address
First Line	:	7383 PARAGON RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4119
Country	:	US
Telephone Number	:	717-746-9005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/12/2024

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Directions to “ KATHERINE A RIDDLE ” Practice Location

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