Provider Demographics
NPI:1174916894
Name:ABBOTT, REGINA (OTR/L)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ABBOTT
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 1:275 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-3816
Mailing Address - Country:US
Mailing Address - Phone:606-307-2695
Mailing Address - Fax:
Practice Address - Street 1:275 DOGWOOD TRL
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-3816
Practice Address - Country:US
Practice Address - Phone:606-307-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist