Provider Demographics
NPI:1063838415
Name:STEPHAN, REGINA (OTR)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 SQUIRRELTAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7632
Mailing Address - Country:US
Mailing Address - Phone:719-352-9707
Mailing Address - Fax:719-434-8479
Practice Address - Street 1:4776 EAGLERIDGE CIRCLE
Practice Address - Street 2:VA EASTERN COLORADO HEALTH CARE SYSTEM
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-250-5011
Practice Address - Fax:719-584-5496
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0002519225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation