Healthcare Provider Details

I. General information

NPI: 1164057428
Provider Name (Legal Business Name): ERIC RILEY MOT, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 7TH AVE
HUNTINGTON WV
25701-2117
US

IV. Provider business mailing address

803 7TH AVE
HUNTINGTON WV
25701-2117
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-1164
  • Fax: 304-522-2474
Mailing address:
  • Phone: 304-523-1164
  • Fax: 304-522-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2095
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: