Provider Demographics
NPI:1316976939
Name:RIDDLE, BETH (OT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2654
Mailing Address - Country:US
Mailing Address - Phone:814-455-0995
Mailing Address - Fax:814-455-0997
Practice Address - Street 1:2402 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2654
Practice Address - Country:US
Practice Address - Phone:814-455-0995
Practice Address - Fax:814-455-0997
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005684L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13362Medicare UPIN
PA078054Medicare ID - Type UnspecifiedPA MEDICARE #