Provider Demographics
NPI:1376217547
Name:CLEMENTI, REGAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:CLEMENTI
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 1:400 ANCHORAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5462
Mailing Address - Country:US
Mailing Address - Phone:630-636-0367
Mailing Address - Fax:
Practice Address - Street 1:9115 E ZAYANTE RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9014
Practice Address - Country:US
Practice Address - Phone:630-636-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19615225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics