MEDICARE: DIANE STEGALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2065X	Child Physical Disabilities Respite Care

General Provider Information

NPI Number	:	1366944886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE STEGALL

Provider Business Mailing Address
First Line	:	1300 STORM DR
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6748
Country	:	US
Telephone Number	:	817-991-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	8745 SAN JOAQUIN TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7836
Country	:	US
Telephone Number	:	817-991-0595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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Directions to “ DIANE STEGALL ” Practice Location

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