Healthcare Provider Details

I. General information

NPI: 1164797999
Provider Name (Legal Business Name): DIONNA NOONAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 S MUMAUGH RD
LIMA OH
45804-3569
US

IV. Provider business mailing address

804 S MUMAUGH RD
LIMA OH
45804-3569
US

V. Phone/Fax

Practice location:
  • Phone: 419-225-9040
  • Fax: 419-225-9835
Mailing address:
  • Phone: 419-225-9040
  • Fax: 419-225-9835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT-5613
License Number StateOH

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: