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General NPI Number Information
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NPI Number | 1215802509
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Entity Type | Individual
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Provider Name | RILEY KATHLEEN CORNACCHINI R-DMT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1802 W BERTEAU AVE
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City | CHICAGO
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State | IL
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Zip | 60613-6181
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Country | US
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Telephone | 708-202-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 N CLARK ST APT 1001
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City | CHICAGO
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State | IL
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Zip | 60610-3612
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Country | US
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Telephone | 248-565-7500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | 3068
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License Number State | IL
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