Provider Demographics
NPI:1689658916
Name:LEFAUVE, REGINA MAE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MAE
Last Name:LEFAUVE
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 1:514 WILLIAMSON RD
Mailing Address - Street 2:SUITE 431
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9225
Mailing Address - Country:US
Mailing Address - Phone:704-641-4461
Mailing Address - Fax:704-896-2686
Practice Address - Street 1:19772 ONE NORMAN BLVD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:980-306-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2414673OtherUNITED HEALTHCARE
D8766OtherMEDCOST
7379530OtherAETNA
1372TOtherBCBS
2414673OtherUNITED HEALTHCARE