Provider Demographics
NPI:1336425107
Name:RUELAS, CARLA REGINA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:REGINA
Last Name:RUELAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:REGINA
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2618 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-3253
Mailing Address - Country:US
Mailing Address - Phone:360-989-8802
Mailing Address - Fax:
Practice Address - Street 1:801 SE PARK CREST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1300
Practice Address - Country:US
Practice Address - Phone:360-260-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility