Provider Demographics
NPI:1639467079
Name:GREENFIELD, REGENIA ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REGENIA
Middle Name:ANN
Last Name:GREENFIELD
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 1:1386 BLUE AND GRAY PARK RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-8973
Mailing Address - Country:US
Mailing Address - Phone:270-604-1545
Mailing Address - Fax:
Practice Address - Street 1:503 ALLENSVILLE STREET
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220
Practice Address - Country:US
Practice Address - Phone:270-265-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist