Provider Demographics
NPI:1518579275
Name:MANZELLA, REBEKKA JEAN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:REBEKKA
Middle Name:JEAN
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 E VILLA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2435
Mailing Address - Country:US
Mailing Address - Phone:626-449-2919
Mailing Address - Fax:
Practice Address - Street 1:2116 E VILLA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2435
Practice Address - Country:US
Practice Address - Phone:310-923-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist