Individual provider Active NPI

Ryan Harley, OTR

  • Occupational Therapist
  • Augusta, GA
National Provider Identifier
1073401923
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT009585 Issued in GA
Practice address
2103 Reedale Ave
Augusta, GA 30906-3430
Phone
(706) 814-6887
NPI assigned
Jun 26, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT009585 GA Primary

Addresses

Primary practice location

2103 Reedale Ave
Augusta, GA 30906-3430

Mailing address

1010 Carolina Ave
Rincon, GA 31326-9141
Phone (912) 677-0077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250708001632 GA Practitioner - Occupational Therapist in Private Practice 3476067984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proactive Rehabilitation and Wellness LLCGroup PAC ID 7517387095, 8 clinicians
Your Aging Therapist LLCGroup PAC ID 6709285992, 8 clinicians

Practice addresses (Care Compare)

2103 Reedale Ave
Augusta, GA 30906-3430
Phone (706) 814-6887

3712 Executive Ctr Dr
Suite a
Martinez, GA 30907-5098
Phone (706) 252-3332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT009585GAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proactive Physical Therapy and Rehabilitation LLC CurrentSince Jun 27, 2025 Accepting new patients
Proactive Rehabilitation & Wellness LLC Occupational Therapist CurrentSince Jun 27, 2025 Accepting new patients
Your Aging Therapist LLC Occupational Therapist CurrentSince Oct 16, 2025 Accepting new patients

Locations

2103 Reedale Ave
Augusta, GA 30906
Phone (706) 414-5058

3712 Executive Center Dr
Ste A
Martinez, GA 30907
Phone (706) 252-3332

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1073401923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 CAROLINA AVE",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313269141",
            "telephone_number": "912-677-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 REEDALE AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063430",
            "telephone_number": "706-814-6887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARLEY",
        "first_name": "RYAN",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-26",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT009585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.