Provider Demographics
NPI:1871549071
Name:BURKE, REGINA MARIE (OTR/L,CHT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:BURKE
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:DESHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3178
Mailing Address - Country:US
Mailing Address - Phone:319-398-1583
Mailing Address - Fax:319-399-2085
Practice Address - Street 1:202 10TH STREET SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2404
Practice Address - Country:US
Practice Address - Phone:319-398-1506
Practice Address - Fax:319-588-4062
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist