Provider Demographics
NPI:1265545479
Name:HAMMOND, REGENIA JACKSON (MPH, OTR/L)
Entity type:Individual
Prefix:MS
First Name:REGENIA
Middle Name:JACKSON
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MPH, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 TIMBERLINE ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2218
Mailing Address - Country:US
Mailing Address - Phone:254-297-3528
Mailing Address - Fax:254-297-5387
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-3528
Practice Address - Fax:254-297-5387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100640OtherSTATE OT LISCNESURE#