Provider Demographics
NPI:1053876797
Name:REYES, JAIDEE MAE (OTR/L)
Entity type:Individual
Prefix:
First Name:JAIDEE MAE
Middle Name:
Last Name:REYES
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 1:30683 RATTLE DANCE WAY
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9329
Mailing Address - Country:US
Mailing Address - Phone:562-884-2982
Mailing Address - Fax:
Practice Address - Street 1:1582 W SAN MARCOS BLVD STE 105B
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:562-884-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-07-09
Deactivation Date:2024-06-21
Deactivation Code:
Reactivation Date:2024-07-05
Provider Licenses
StateLicense IDTaxonomies
CA25479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist