Healthcare Provider Details

I. General information

NPI: 1245745611
Provider Name (Legal Business Name): KRISTY LACOLE RIFFE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DUNCAN RD
BUCKEYE WV
24924-9037
US

IV. Provider business mailing address

150 DUNCAN RD
BUCKEYE WV
24924-9037
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-7400
  • Fax:
Mailing address:
  • Phone: 304-799-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2185
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2411
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: