Provider Demographics
NPI:1942857701
Name:MASTROBATTISTA, REGINA GAIL
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:GAIL
Last Name:MASTROBATTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LISA BETH CIR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4373
Mailing Address - Country:US
Mailing Address - Phone:603-812-6480
Mailing Address - Fax:
Practice Address - Street 1:615 HEATH ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2160
Practice Address - Country:US
Practice Address - Phone:617-243-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty