Healthcare Provider Details

I. General information

NPI: 1750102901
Provider Name (Legal Business Name): DIANA PREDA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 HATCHERY RD
WATERFORD MI
48329-3435
US

IV. Provider business mailing address

501 N CASS LAKE RD
WATERFORD MI
48328-2307
US

V. Phone/Fax

Practice location:
  • Phone: 248-674-0331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201013862
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: