Provider Demographics
NPI:1336601749
Name:RILEE, JESSICA J (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:RILEE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 HAWTHORNE RIDGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:HARWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20776-2710
Mailing Address - Country:US
Mailing Address - Phone:443-867-2979
Mailing Address - Fax:
Practice Address - Street 1:5630 SHARON DR
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9359
Practice Address - Country:US
Practice Address - Phone:443-867-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist