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NPI Code Detail

MEDICARE: RILEY HEARN OTR/L

MEDICARE: RILEY HEARN OTR/L
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
1225X00000XOccupational Therapist0119011362VA

General Provider Information

NPI Number : 1205775434
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY HEARN OTR/L
Provider Business Mailing Address
First Line : 4365 STARKEY RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-0610
Country : US
Telephone Number : 540-527-5068
Fax Number : 540-527-5093
Provider Business Practice Location Address
First Line : 4365 STARKEY RD
Second Line :
City : ROANOKE
State : VA
Zip : 24018-0610
Country : US
Telephone Number : 540-527-5068
Fax Number : 540-527-5093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/25/2026

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