Provider Demographics
NPI:1124116934
Name:RIEKE, NANCY B (OTR/L)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:RIEKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 W WERNETT RD
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2091
Mailing Address - Country:US
Mailing Address - Phone:509-544-9584
Mailing Address - Fax:
Practice Address - Street 1:552 N COLORADO ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7779
Practice Address - Country:US
Practice Address - Phone:509-736-6060
Practice Address - Fax:509-736-3939
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001907225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8851921Medicare ID - Type UnspecifiedMEDICARE ID#