Healthcare Provider Details

I. General information

NPI: 1538222815
Provider Name (Legal Business Name): DIANA RILEY IECE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMPSON RD
MOUTHCARD KY
41548-8477
US

IV. Provider business mailing address

75 THOMPSON RD
MOUTHCARD KY
41548-8477
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-4110
  • Fax: 606-835-4110
Mailing address:
  • Phone: 606-835-4110
  • Fax: 606-835-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: