Provider Demographics
NPI:1295277796
Name:MCCALL, REGINA (MPT)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6758 GRAYBIRCH KNL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8590
Mailing Address - Country:US
Mailing Address - Phone:513-737-3098
Mailing Address - Fax:
Practice Address - Street 1:6758 GRAYBIRCH KNL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8590
Practice Address - Country:US
Practice Address - Phone:513-737-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-009781251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)