MEDICARE: JOSEPH RIORDAN

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	224Z00000X	Occupational Therapy Assistant	OTA000990	GA

General Provider Information

NPI Number	:	1770828691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RIORDAN

Provider Business Mailing Address
First Line	:	2850 SPRINGDALE RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7802
Country	:	US
Telephone Number	:	404-762-8672
Fax Number	:	404-768-8630

Provider Business Practice Location Address
First Line	:	2850 SPRINGDALE RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7802
Country	:	US
Telephone Number	:	404-762-8672
Fax Number	:	404-768-8630

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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Directions to “ JOSEPH RIORDAN ” Practice Location

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