Healthcare Provider Details

I. General information

NPI: 1104429646
Provider Name (Legal Business Name): BOBBI DIEHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BIG SPRING RD
NEWVILLE PA
17241-9497
US

IV. Provider business mailing address

13 MORARI DR
DILLSBURG PA
17019-1555
US

V. Phone/Fax

Practice location:
  • Phone: 717-776-8200
  • Fax:
Mailing address:
  • Phone: 412-443-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP008112
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: