Provider Demographics
NPI:1154767085
Name:RILEY, DENISE STRATTON
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:STRATTON
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:STRATTON
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:3631 E WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2559
Mailing Address - Country:US
Mailing Address - Phone:434-444-2754
Mailing Address - Fax:
Practice Address - Street 1:3631 E WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2559
Practice Address - Country:US
Practice Address - Phone:434-444-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001105224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant