Provider Demographics
NPI:1265753586
Name:REGAN, DENISE ANN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ANN
Last Name:REGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:459 BEACH 130TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1524
Mailing Address - Country:US
Mailing Address - Phone:917-843-8954
Mailing Address - Fax:
Practice Address - Street 1:459 BEACH 130TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1524
Practice Address - Country:US
Practice Address - Phone:917-843-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist