Healthcare Provider Details

I. General information

NPI: 1760111520
Provider Name (Legal Business Name): CASSANDRA MARIE RILEY INHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 WEBER AVE
LOUISVILLE KY
40205-2113
US

IV. Provider business mailing address

2214 WEBER AVE
LOUISVILLE KY
40205-2113
US

V. Phone/Fax

Practice location:
  • Phone: 317-525-0350
  • Fax:
Mailing address:
  • Phone: 317-525-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: