Provider Demographics
NPI:1558729236
Name:COTTER, REGAN (ECDS)
Entity Type:Individual
Prefix:MS
First Name:REGAN
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:ECDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LIBERTY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9004
Mailing Address - Country:US
Mailing Address - Phone:870-710-1336
Mailing Address - Fax:870-368-4587
Practice Address - Street 1:889 E. MAIN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556
Practice Address - Country:US
Practice Address - Phone:870-368-4586
Practice Address - Fax:870-368-4587
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist