Provider Demographics
NPI:1760850788
Name:MEDIROS, MARIA REGINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA REGINA
Middle Name:
Last Name:MEDIROS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA REGINA
Other - Middle Name:
Other - Last Name:LIVITRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7150 GRANITE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-3114
Mailing Address - Country:US
Mailing Address - Phone:419-365-6665
Mailing Address - Fax:419-365-6665
Practice Address - Street 1:2045 FRANKS PKWY
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6254
Practice Address - Country:US
Practice Address - Phone:419-843-9759
Practice Address - Fax:419-333-1960
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist