Healthcare Provider Details

I. General information

NPI: 1801138532
Provider Name (Legal Business Name): BETH A RISNER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH A WARKENTIEN

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 BROADWAY
MERRILLVILLE IN
46410-6220
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-7211
  • Fax: 219-769-7236
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31005453A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: