Marissa Diane Reynolds

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

19337 Issued in CA

Practice address

22691 Lambert St Ste 502
Lake Forest, CA 92630-1614

Phone

(949) 273-6503

NPI assigned

Jul 9, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Infinity Kids Corporation

  • Occupational Therapist
  • Lake Forest, CA
  • NPI 1730673153
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1841037702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22691 LAMBERT ST STE 502",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22691 LAMBERT ST STE 502",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301614",
            "telephone_number": "949-273-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MARISSA",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "19337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Reilly, MOT, OTR/L
• Restorative Therapy Associates
• Retina Medical Group
• Rex Chuang, DDS, Inc.
• Julie Reyes, MAOM, LAC, DC
• Reza Dehdari MD Inc
• Richard R Moy, D.P.M., Inc
• Christine Richards
• Rana Richeh, MD
• Diane Michelle Riffe

• Speech-Language Pathologist in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.