Healthcare Provider Details

I. General information

NPI: 1013854900
Provider Name (Legal Business Name): RIELLY DOUD OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E MAIN ST
PANORA IA
50216-1055
US

IV. Provider business mailing address

1126 LEWIS AVE
CASEY IA
50048-8516
US

V. Phone/Fax

Practice location:
  • Phone: 641-755-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115489
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: