MEDICARE: MS. DIANA LEE MADRID OTA 7665

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	224Z00000X	Occupational Therapy Assistant	OTA 7665	FL

General Provider Information

NPI Number	:	1750540928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA LEE MADRID OTA 7665

Provider Business Mailing Address
First Line	:	817 OAK ST
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-6415
Country	:	US
Telephone Number	:	352-860-2222
Fax Number	:	352-860-2223

Provider Business Practice Location Address
First Line	:	817 OAK ST
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-6415
Country	:	US
Telephone Number	:	352-860-2222
Fax Number	:	352-860-2223

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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