Provider Demographics
NPI:1235936121
Name:RIDDELL, REBECCA (MOT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RIDDELL
Suffix:
Gender:
Credentials:MOT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:RIDDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOT
Mailing Address - Street 1:39609 WANDERLY DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-0314
Mailing Address - Country:US
Mailing Address - Phone:442-515-2153
Mailing Address - Fax:
Practice Address - Street 1:25467 MEDICAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1501
Practice Address - Country:US
Practice Address - Phone:951-899-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist