Healthcare Provider Details

I. General information

NPI: 1730013988
Provider Name (Legal Business Name): MR. REGIS D MOTLEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 SYLVAN DR
DAYTON OH
45417-1246
US

IV. Provider business mailing address

4606 SYLVAN DR
DAYTON OH
45417-1246
US

V. Phone/Fax

Practice location:
  • Phone: 243-242-5388
  • Fax:
Mailing address:
  • Phone: 943-242-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: