Provider Demographics
NPI:1366296634
Name:RILEY, SARA JUNE (COTA/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JUNE
Last Name:RILEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JUNE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3230 CENTENNIAL RD LOT 41
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9744
Mailing Address - Country:US
Mailing Address - Phone:419-509-7326
Mailing Address - Fax:
Practice Address - Street 1:20311 PEMBERVILLE RD
Practice Address - Street 2:
Practice Address - City:PEMBERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43450-9413
Practice Address - Country:US
Practice Address - Phone:419-833-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-3061224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant