Healthcare Provider Details

I. General information

NPI: 1801716139
Provider Name (Legal Business Name): AMY JO RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 BOULEVARD ST
DOVER OH
44622-2026
US

IV. Provider business mailing address

2336 WAINWRIGHT RD SE
NEW PHILADELPHIA OH
44663-6837
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-3311
  • Fax:
Mailing address:
  • Phone: 330-343-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number298242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: