Provider Demographics
NPI:1871902486
Name:KAUFMAN, REGINA (MA)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 KEELERS CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2180
Mailing Address - Country:US
Mailing Address - Phone:904-285-0619
Mailing Address - Fax:
Practice Address - Street 1:1212 13TH ST N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3682
Practice Address - Country:US
Practice Address - Phone:727-741-4305
Practice Address - Fax:904-306-7826
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist