Provider Demographics
NPI:1174235063
Name:BUIS, RILEY NICOLE (COTA/L)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:NICOLE
Last Name:BUIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6653 BLUE SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80530-6712
Mailing Address - Country:US
Mailing Address - Phone:720-838-1901
Mailing Address - Fax:
Practice Address - Street 1:6653 BLUE SPRUCE ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80530-6712
Practice Address - Country:US
Practice Address - Phone:720-838-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001619224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant