Provider Demographics
NPI:1386440170
Name:COACH, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:COACH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:REGINALD
Other - Middle Name:
Other - Last Name:COACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5818 CHARTEROAK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2016
Mailing Address - Country:US
Mailing Address - Phone:513-238-3060
Mailing Address - Fax:
Practice Address - Street 1:5818 CHARTEROAK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2016
Practice Address - Country:US
Practice Address - Phone:513-238-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide