Individual
BRANDON RYLE REGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 FAIRFIELD ST, WEST MONROE, LA 71291-4612
(318) 324-1611
Mailing address
200 FAIRFIELD ST, WEST MONROE, LA 71291-4612
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
207608
TX
224Z00000X
Occupational Therapy Assistant
Primary
Z20286
LA
Other
Enumeration date
07/19/2011
Last updated
07/19/2011
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