Healthcare Provider Details

I. General information

NPI: 1700030897
Provider Name (Legal Business Name): DIANNE ELAINE KING OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2008
Last Update Date: 11/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 E COUNTY ROAD 300 S
PLAINFIELD IN
46168-9604
US

IV. Provider business mailing address

8580 E COUNTY ROAD 300 S
PLAINFIELD IN
46168-9604
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-7435
  • Fax: 317-331-1074
Mailing address:
  • Phone: 317-839-7435
  • Fax: 317-331-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number31000363A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: