Provider Demographics
NPI:1972904118
Name:ELDRIDGE, REGINA MILLER (OT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MILLER
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:FAYE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 3202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2280
Mailing Address - Country:US
Mailing Address - Phone:859-264-8868
Mailing Address - Fax:859-264-8878
Practice Address - Street 1:1054 CENTER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3851
Practice Address - Country:US
Practice Address - Phone:859-625-0600
Practice Address - Fax:859-625-0969
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY148285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK092820Medicare Oscar/Certification