Provider Demographics
NPI:1083112783
Name:O'MALLEY, REBECCA PEARLE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:PEARLE
Last Name:O'MALLEY
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 1:210 BESANT RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2342
Mailing Address - Country:US
Mailing Address - Phone:805-844-7797
Mailing Address - Fax:
Practice Address - Street 1:1317 DEL NORTE RD STE 105
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8600
Practice Address - Country:US
Practice Address - Phone:805-616-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11680235Z00000X
CA27594235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty