Provider Demographics
NPI:1134347198
Name:SULEY, RITA HELENE (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:HELENE
Last Name:SULEY
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRANADA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7725
Mailing Address - Country:US
Mailing Address - Phone:805-383-1501
Mailing Address - Fax:805-384-0478
Practice Address - Street 1:155 GRANADA ST
Practice Address - Street 2:SUITE A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7725
Practice Address - Country:US
Practice Address - Phone:805-383-1501
Practice Address - Fax:805-384-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4316225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics