Healthcare Provider Details

I. General information

NPI: 1083525703
Provider Name (Legal Business Name): RILEY CADENCE POTCHKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E RUDISILL BLVD STE B100
FORT WAYNE IN
46806-1752
US

IV. Provider business mailing address

11214 YALUMBA PASS
ROANOKE IN
46783-8933
US

V. Phone/Fax

Practice location:
  • Phone: 260-255-3665
  • Fax:
Mailing address:
  • Phone: 260-299-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: