=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063909091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARRISON RILEY HOCKER BCBA, LBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2018
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 W LINCOLN AVE
-----------------------------------------------------
City | GOSHEN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46526-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-387-4313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4525 E CLINTON TRL
-----------------------------------------------------
City | EATON RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48827-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-501-6587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------