Healthcare Provider Details

I. General information

NPI: 1134145436
Provider Name (Legal Business Name): DIANNE C MARCH O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 CENTENNIAL BLVD STE 200
COLORADO SPRINGS CO
80907-4090
US

IV. Provider business mailing address

3470 CENTENNIAL BLVD SUITE 200
COLORADO SPRINGS CO
80907-4090
US

V. Phone/Fax

Practice location:
  • Phone: 719-260-4767
  • Fax: 719-260-4765
Mailing address:
  • Phone: 719-260-4767
  • Fax: 719-260-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTAA54427
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: