MEDICARE: MS. DOREEN ANN RIEGAL MS

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	46TR00154200	NJ

General Provider Information

NPI Number	:	1245663558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOREEN ANN RIEGAL MS

Provider Business Mailing Address
First Line	:	7 CENTER ST UNIT 3310
Second Line	:
City	:	OCEAN
State	:	NJ
Zip	:	07712-3824
Country	:	US
Telephone Number	:	732-859-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3349 ROUTE 138 BLDG SUITEA
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9671
Country	:	US
Telephone Number	:	732-280-6050
Fax Number	:

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

Provider Enumeration Date	:	08/11/2013
Last Update Date	:	08/11/2013

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