Provider Demographics
NPI:1134364946
Name:WILKENING, REGINA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:WILKENING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:503 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7344
Mailing Address - Country:US
Mailing Address - Phone:208-559-4538
Mailing Address - Fax:208-345-5458
Practice Address - Street 1:503 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-7344
Practice Address - Country:US
Practice Address - Phone:208-559-4538
Practice Address - Fax:208-345-5458
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist