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NPI Code Detail

MEDICARE: DEANNA RILEY OTR

MEDICARE: DEANNA RILEY OTR
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
1224Z00000XOccupational Therapy Assistant1766-026WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396804944
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA RILEY OTR
Provider Business Mailing Address
First Line : 2652 W MEDFORD AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53206-1027
Country : US
Telephone Number : 414-265-4516
Fax Number :
Provider Business Practice Location Address
First Line : 6800 N 76TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-5002
Country : US
Telephone Number : 414-353-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 07/08/2007

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