Provider Demographics
NPI:1285098640
Name:GARLAND, REGINA ANN
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:GARLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:102 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-3321
Mailing Address - Country:US
Mailing Address - Phone:828-734-1322
Mailing Address - Fax:
Practice Address - Street 1:100 SILVER BLUFF DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-6350
Practice Address - Country:US
Practice Address - Phone:828-648-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2831224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant