Provider Demographics
NPI:1316985161
Name:RILEY, MARLENE A (OTR)
Entity type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7348
Mailing Address - Country:US
Mailing Address - Phone:443-212-8363
Mailing Address - Fax:410-705-2273
Practice Address - Street 1:7609 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7348
Practice Address - Country:US
Practice Address - Phone:443-212-8363
Practice Address - Fax:410-705-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01403225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD558054400Medicaid
GL70-0000OtherBLUECROSS BLUESHIELD CARE FIRST
9672823OtherCIGNA
MD100SMedicare ID - Type UnspecifiedNUMBER