Healthcare Provider Details

I. General information

NPI: 1407482797
Provider Name (Legal Business Name): RILEY PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HWY 27 STE B201
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

2400 S HWY 27 STE B201
CLERMONT FL
34711-6816
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone: 352-394-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA17192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: