Provider Demographics
NPI:1902265044
Name:HILLEBRECHT, REGAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:HILLEBRECHT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-4135
Mailing Address - Country:US
Mailing Address - Phone:860-837-4339
Mailing Address - Fax:
Practice Address - Street 1:59 N PARK ST
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-4135
Practice Address - Country:US
Practice Address - Phone:860-837-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist