MEDICARE: KALLIHAN MARY HANNAH RILEY OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2019038039	MO

General Provider Information

NPI Number	:	1194386623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALLIHAN MARY HANNAH RILEY OTD

Provider Business Mailing Address
First Line	:	502 HOUSTON ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1760
Country	:	US
Telephone Number	:	815-209-7917
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 HOUSTON ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1760
Country	:	US
Telephone Number	:	815-209-7917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	01/06/2020

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