Healthcare Provider Details

I. General information

NPI: 1629208491
Provider Name (Legal Business Name): MIRANDA DAWN RIFFLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA DAWN MORGAN

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BALLINGTON BLVD NW
ROCHESTER MN
55901-5202
US

IV. Provider business mailing address

520 MULLIGAN DRIVE
ZUMBROTA MN
55992
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-5514
  • Fax:
Mailing address:
  • Phone: 219-805-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1389
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107467
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31007825A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: