Provider Demographics
NPI:1366918161
Name:RIGGS, LARRY DOUGLAS JR (COTALL)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DOUGLAS
Last Name:RIGGS
Suffix:JR
Gender:M
Credentials:COTALL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BRIDY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38483-7110
Mailing Address - Country:US
Mailing Address - Phone:931-629-3551
Mailing Address - Fax:
Practice Address - Street 1:2380 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4809
Practice Address - Country:US
Practice Address - Phone:931-762-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1997224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant