Basic Information
| Provider Information | |||||||||
| NPI: | 1821475310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPAAY | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 703 | ||||||||
| Address2: | |||||||||
| City: | MEEKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816410703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702202245 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 542 16TH ST | ||||||||
| Address2: | |||||||||
| City: | RAWLINS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 823015241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073242759 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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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 | 172V00000X | PT-1417 | WY | Y | Other Service Providers | Community Health Worker |
No ID Information.