Basic Information
| Provider Information | |||||||||
| NPI: | 1194257246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGAN | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 DENNIS ST SW | ||||||||
| Address2: | STE B | ||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985016523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603380181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 W 5TH AVE STE 308 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096242353 | ||||||||
| FaxNumber: | 5096242501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT60732419 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.