Provider Demographics
NPI:1821435926
Name:REGAN, JENNY MAREE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MAREE
Last Name:REGAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:JENNY
Other - Middle Name:MAREE
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12881 KNOTT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3939
Mailing Address - Country:US
Mailing Address - Phone:714-892-6828
Mailing Address - Fax:714-898-9720
Practice Address - Street 1:12881 KNOTT ST STE 103
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3939
Practice Address - Country:US
Practice Address - Phone:714-892-6828
Practice Address - Fax:714-898-9720
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2522224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant