Provider Demographics
NPI:1518456532
Name:REUST, LORETTA ELLEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:ELLEN
Last Name:REUST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:ELLEN
Other - Last Name:PEFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:24001 WILDWOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3817
Mailing Address - Country:US
Mailing Address - Phone:661-714-6466
Mailing Address - Fax:
Practice Address - Street 1:26639 VALLEY CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-2376
Practice Address - Country:US
Practice Address - Phone:661-254-1842
Practice Address - Fax:661-254-1862
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4764225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics