Healthcare Provider Details

I. General information

NPI: 1275557308
Provider Name (Legal Business Name): DIANE MICHELLE THOMAS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE MICHELLE WALDSMITH OT

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 WHIPPLE AVE NW SUITE 200
CANTON OH
44708-6215
US

IV. Provider business mailing address

4645 BELPAR ST NW
CANTON OH
44718-3602
US

V. Phone/Fax

Practice location:
  • Phone: 330-478-1752
  • Fax: 330-478-1763
Mailing address:
  • Phone: 330-493-4210
  • Fax: 330-493-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 005076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: