=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053243493
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS RILEY E BECKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2026
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 LA ROSA LN
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-704-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 HARBOR PKWY
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06413-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-908-8322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------