Provider Demographics
NPI:1710312038
Name:RUDDELL, MONIQUE ELIANA (OTD, OTR/L, CHT)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:ELIANA
Last Name:RUDDELL
Suffix:
Gender:F
Credentials:OTD, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4669
Mailing Address - Country:US
Mailing Address - Phone:323-917-5194
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 407
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4669
Practice Address - Country:US
Practice Address - Phone:323-917-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT13120225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand