MEDICARE: DR. REGINA ROSE GEGNER OTD, OTR/L, CEES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XE1200X	Ergonomics Occupational Therapist		IN
2	225XP0019X	Physical Rehabilitation Occupational Therapist		IN
3	225X00000X	Occupational Therapist	31007873A	IN

General Provider Information

NPI Number	:	1639914112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA ROSE GEGNER OTD, OTR/L, CEES

Provider Business Mailing Address
First Line	:	4139 VIVA LANE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4139 VIVA LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-1913
Country	:	US
Telephone Number	:	330-957-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	07/02/2024

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