MEDICARE: RYLIE POWER OTD, 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
1	225X00000X	Occupational Therapist	0119008167	VA

General Provider Information

NPI Number	:	1306500293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLIE POWER OTD, OTR/L

Provider Business Mailing Address
First Line	:	2815 3RD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-3915
Country	:	US
Telephone Number	:	804-332-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 3RD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-3915
Country	:	US
Telephone Number	:	804-332-3987
Fax Number	:

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

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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