Healthcare Provider Details

I. General information

NPI: 1023234697
Provider Name (Legal Business Name): DIANA ZWICKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD SUITE 240
PLYMOUTH MEETING PA
19462-1047
US

IV. Provider business mailing address

30 CONANT ST APT. 3
DANVERS MA
01923-2936
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-1122
  • Fax:
Mailing address:
  • Phone: 978-777-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: