Basic Information
| Provider Information | |||||||||
| NPI: | 1366922908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | REGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5911 WISDOM CREEK DR | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752492823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828024805 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 S CLARK RD | ||||||||
| Address2: | |||||||||
| City: | CEDAR HILL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751042750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722917877 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 214505 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.