Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT17141 | CA |
NPI | 1003340944 |
---|---|
Provider Name | Hollyann Elise Riley |
First Address | Twentynine Palms, CA 92277-2356 |
Second Address | Twentynine Palms, CA 92277-2356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 12/08/2020 |