=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073805560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAH DIEKER OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2011
-----------------------------------------------------
Last Update Date | 05/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5755 MARK DABLING BLVD SUITE 101
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80919-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-630-8099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6580 QUARTER CIRCLE RD
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80922-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-237-9556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2786
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------