Healthcare Provider Details

I. General information

NPI: 1477678787
Provider Name (Legal Business Name): JENNIFER LYNN RIEL OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLEASANT ST
CONCORD NH
03301-7504
US

IV. Provider business mailing address

7 SWIFTWATER DR UNIT 5
ALLENSTOWN NH
03275-1835
US

V. Phone/Fax

Practice location:
  • Phone: 603-410-3419
  • Fax: 603-229-4586
Mailing address:
  • Phone: 603-568-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1727
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: