Provider Demographics
NPI:1326469354
Name:BROOKS, REGINA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2079
Mailing Address - Country:US
Mailing Address - Phone:614-312-0861
Mailing Address - Fax:
Practice Address - Street 1:1298 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2079
Practice Address - Country:US
Practice Address - Phone:614-312-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management