Healthcare Provider Details

I. General information

NPI: 1730774464
Provider Name (Legal Business Name): MAGGI DIANE COLWELL MS, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAGGI DIANE HORSEMAN MS, ATR-BC

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 BURLINGTON AVE
COLUMBUS OH
43227-3633
US

IV. Provider business mailing address

1693 BURLINGTON AVE
COLUMBUS OH
43227-3633
US

V. Phone/Fax

Practice location:
  • Phone: 614-800-9508
  • Fax:
Mailing address:
  • Phone: 614-800-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATG221
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberAT-0010005
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: