Provider Demographics
NPI:1871354894
Name:MOTA, RYLEE ALEXIS (ATC)
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:ALEXIS
Last Name:MOTA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:RYLEE
Other - Middle Name:ALEXIS
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2830 CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9655
Mailing Address - Country:US
Mailing Address - Phone:619-846-9644
Mailing Address - Fax:
Practice Address - Street 1:2830 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-9655
Practice Address - Country:US
Practice Address - Phone:619-846-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000555202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer