Individual
KEISIA RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2058 DEL RIO DR, ARNOLD, MO 63010-4112
(618) 922-6154
Mailing address
2058 DEL RIO DR, ARNOLD, MO 63010-4112
(618) 922-6154
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2016010243
MO
225700000X
Massage Therapist
227007170
IL
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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