Individual
EDWIN DAVE RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
6177 RIVER CREST DR, #A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Mailing address
14033 MONTECITO DR, VICTORVILLE, CA 92395-4718
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 7710
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT7710
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
CA
Enumeration date
03/19/2014
Last updated
03/19/2014
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