1639914112 NPI number — REGINA ROSE GEGNER OTD, OTR/L, CEES

NPI Number: 1639914112
Health Care Provider/Practitioner: REGINA ROSE GEGNER OTD, OTR/L, CEES

NPI Number : 1639914112 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639914112",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GEGNER",
    "FirstName": "REGINA",
    "MiddleName": "ROSE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OTD, OTR/L, CEES",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "REILLY",
    "OtherFirstName": "REGINA",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "OTD, OTR/L, CEES",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4139 VIVA LANE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46239",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4139 VIVA LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46239-1913",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "330-957-0300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/27/2024",
    "LastUpdateDate": "07/02/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225XE1200X",
          "TaxonomyName": "Ergonomics Occupational Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225XP0019X",
          "TaxonomyName": "Physical Rehabilitation Occupational Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "31007873A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}