Individual
MR. JEFFERY GEORGE RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
245 N GORDON DR, WINSTON SALEM, NC 27104-2822
(336) 529-6835
Mailing address
245 N GORDON DR, WINSTON SALEM, NC 27104-2822
(336) 529-6836
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0999
NC
251E00000X
Home Health Agency
0999
NC
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
0999
NC
Other
Enumeration date
05/19/2011
Last updated
05/19/2011
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