Healthcare Provider Details

I. General information

NPI: 1518883263
Provider Name (Legal Business Name): RILEY HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 CENTRAL AVE STE 1
FORT MYERS FL
33901-7647
US

IV. Provider business mailing address

3661 CENTRAL AVE
FORT MYERS FL
33901-8218
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-5872
  • Fax:
Mailing address:
  • Phone: 239-245-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-547467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: