Provider Demographics
NPI:1194257246
Name:REGAN, MELISSA (OT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DENNIS ST SW
Mailing Address - Street 2:STE B
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:
Practice Address - Street 1:601 W 5TH AVE STE 308
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2714
Practice Address - Country:US
Practice Address - Phone:509-624-2353
Practice Address - Fax:509-624-2501
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60732419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist