Provider Demographics
NPI:1891108049
Name:REGULA, BRANDALYN (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRANDALYN
Middle Name:
Last Name:REGULA
Suffix:
Gender:F
Credentials:MOT, 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:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:OH
Mailing Address - Zip Code:43804-0371
Mailing Address - Country:US
Mailing Address - Phone:330-897-9034
Mailing Address - Fax:
Practice Address - Street 1:834 E HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3052
Practice Address - Country:US
Practice Address - Phone:330-308-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007632225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist