Provider Demographics
NPI:1710598222
Name:COOPER, REGAN LEIGH (OT)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:LEIGH
Last Name:COOPER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-9360
Mailing Address - Country:US
Mailing Address - Phone:870-464-1337
Mailing Address - Fax:
Practice Address - Street 1:3163 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-9360
Practice Address - Country:US
Practice Address - Phone:870-464-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist