Provider Demographics
NPI:1558545665
Name:COOKS, REGINA NATEYA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:NATEYA
Last Name:COOKS
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 1:379 PINEHAVEN ST EXT
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4940 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:310
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1599
Practice Address - Country:US
Practice Address - Phone:888-416-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30333140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric