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General NPI Number Information
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NPI Number | 1174884100
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Entity Type | Individual
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Provider Name | ADRIENNE KELLY DIETRICH M.S., ED.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 18564 US ROUTE 11 SUITE 5
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City | WATERTOWN
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State | NY
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Zip | 13601-5900
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Country | US
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Telephone | 315-786-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 7289 RICE RD
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City | LOWVILLE
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State | NY
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Zip | 13367-9600
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Country | US
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Telephone | 315-376-4208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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