Provider Demographics
NPI:1871213603
Name:WLOS, RILEY ANN
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:ANN
Last Name:WLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24132 S INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-8435
Mailing Address - Country:US
Mailing Address - Phone:708-212-6140
Mailing Address - Fax:
Practice Address - Street 1:19227 JUNIPER LN
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8132
Practice Address - Country:US
Practice Address - Phone:630-673-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
056.015056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist