Provider Demographics
NPI:1629208491
Name:RIFFLE, MIRANDA DAWN (OTR/L)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DAWN
Last Name:RIFFLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:DAWN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 MULLIGAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992
Mailing Address - Country:US
Mailing Address - Phone:219-805-2539
Mailing Address - Fax:
Practice Address - Street 1:8 ROSE ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1678
Practice Address - Country:US
Practice Address - Phone:304-363-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5408225X00000X
IN31007825A225X00000X
WV1389225X00000X
MN107467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist