Provider Demographics
NPI:1043513088
Name:BARKER, REGINA NICHOLS (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:NICHOLS
Last Name:BARKER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 SAIL BOAT LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8144
Mailing Address - Country:US
Mailing Address - Phone:901-745-7595
Mailing Address - Fax:
Practice Address - Street 1:3775 SAIL BOAT LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8144
Practice Address - Country:US
Practice Address - Phone:901-745-7595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000004165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist