Provider Demographics
NPI:1083873731
Name:CALLAHAN, REGINA M (LMT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20421 RAE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2760
Mailing Address - Country:US
Mailing Address - Phone:541-647-1340
Mailing Address - Fax:
Practice Address - Street 1:243 SCALE HOUSE LOOP
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1558
Practice Address - Country:US
Practice Address - Phone:541-647-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist