MEDICARE: MRS. DIANNE ELAINE KING OTR

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	225XG0600X	Gerontology Occupational Therapist	31000363A	IN

General Provider Information

NPI Number	:	1700030897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE ELAINE KING OTR

Provider Business Mailing Address
First Line	:	8580 E COUNTY ROAD 300 S
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-9604
Country	:	US
Telephone Number	:	317-839-7435
Fax Number	:	317-331-1074

Provider Business Practice Location Address
First Line	:	8580 E COUNTY ROAD 300 S
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-9604
Country	:	US
Telephone Number	:	317-839-7435
Fax Number	:	317-331-1074

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

Provider Enumeration Date	:	11/16/2008
Last Update Date	:	11/16/2008

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