Provider Demographics
NPI:1568899151
Name:REGIS, BETHANY (OTR/L)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:REGIS
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 1:80 DEACONESS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4168
Mailing Address - Country:US
Mailing Address - Phone:978-369-5151
Mailing Address - Fax:
Practice Address - Street 1:80 DEACONESS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4168
Practice Address - Country:US
Practice Address - Phone:978-369-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist