Provider Demographics
NPI:1508425562
Name:LONGTIN, REGAN ELIZABETH (OTD)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:ELIZABETH
Last Name:LONGTIN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W 47TH PL APT 324
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1880
Mailing Address - Country:US
Mailing Address - Phone:515-418-1986
Mailing Address - Fax:
Practice Address - Street 1:3715 W 133RD ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3347
Practice Address - Country:US
Practice Address - Phone:913-515-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist