Healthcare Provider Details

I. General information

NPI: 1225932387
Provider Name (Legal Business Name): WENDY JO REGULSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 ATLANTA HWY
CUMMING GA
30040-2707
US

IV. Provider business mailing address

560 RIVER MIST DR
SUWANEE GA
30024-6845
US

V. Phone/Fax

Practice location:
  • Phone: 678-462-4014
  • Fax:
Mailing address:
  • Phone: 678-462-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT001888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: