MEDICARE: DIANA L. H. HIEBELER MA, 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	225XP0200X	Pediatric Occupational Therapist	100677	TX

General Provider Information

NPI Number	:	1962578492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA L. H. HIEBELER MA, OTR

Provider Business Mailing Address
First Line	:	11501 JOHNSON RD
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-5823
Country	:	US
Telephone Number	:	512-267-5852
Fax Number	:

Provider Business Practice Location Address
First Line	:	12501 HYMEADOW DR
Second Line	:	BLDG. 1, SUITE F
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	512-331-5488
Fax Number	:	512-331-5489

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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