Provider Demographics
NPI:1679202873
Name:RIEKEN, BAILIE NICHOLE SCHIPPER (OTR)
Entity type:Individual
Prefix:MRS
First Name:BAILIE
Middle Name:NICHOLE SCHIPPER
Last Name:RIEKEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BAILIE
Other - Middle Name:NICHOLE
Other - Last Name:SCHIPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1306 HIGHWAY 57 STE B
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-1075
Mailing Address - Country:US
Mailing Address - Phone:319-346-9783
Mailing Address - Fax:319-346-9785
Practice Address - Street 1:1306 HIGHWAY 57 STE B
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-1075
Practice Address - Country:US
Practice Address - Phone:319-346-9783
Practice Address - Fax:319-346-9785
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist