Provider Demographics
NPI:1639914112
Name:GEGNER, REGINA ROSE (OTD, OTR/L, CEES)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:ROSE
Last Name:GEGNER
Suffix:
Gender:F
Credentials:OTD, OTR/L, CEES
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:ROSE
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L, CEES
Mailing Address - Street 1:4139 VIVA LANE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4139 VIVA LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-1913
Practice Address - Country:US
Practice Address - Phone:330-957-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225XE1200X, 225XP0019X
IN31007873A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation