MEDICARE: DIANE OSBORNE OTR/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist	090	NC

General Provider Information

NPI Number	:	1972889020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE OSBORNE OTR/L

Provider Business Mailing Address
First Line	:	9511 WHITE CARRIAGE DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6721
Country	:	US
Telephone Number	:	919-818-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 WHITE CARRIAGE DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6721
Country	:	US
Telephone Number	:	919-818-3155
Fax Number	:

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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