Healthcare Provider Details

I. General information

NPI: 1841115797
Provider Name (Legal Business Name): RILEY GILGE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3835 SUPREME CT NW STE 2
BEMIDJI MN
56601-4485
US

IV. Provider business mailing address

3835 SUPREME CT NW STE 2
BEMIDJI MN
56601-4485
US

V. Phone/Fax

Practice location:
  • Phone: 218-444-8280
  • Fax: 218-444-8337
Mailing address:
  • Phone: 218-444-8280
  • Fax: 218-444-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number108182
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: