Healthcare Provider Details

I. General information

NPI: 1497279947
Provider Name (Legal Business Name): DIANE GERALYN VANBUSKIRK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DIANE GERALYN NASUTA

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 DANIELS RD STE 106
WINTER GARDEN FL
34787-7013
US

IV. Provider business mailing address

3131 DANIELS RD STE 106
WINTER GARDEN FL
34787-7013
US

V. Phone/Fax

Practice location:
  • Phone: 407-614-0575
  • Fax:
Mailing address:
  • Phone: 407-614-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT2403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: