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General NPI Number Information
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NPI Number | 1659659365
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Entity Type | Individual
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Provider Name | KATY DIAMOND OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 225 HOPMEADOW ST SUITE 500
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City | WEATOGUE
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State | CT
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Zip | 06089-9782
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Country | US
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Telephone | 860-777-5241
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Fax |
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Provider Business Mailing Address
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Address Line | 225 HOPMEADOW ST SUITE 500
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City | WEATOGUE
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State | CT
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Zip | 06089-9782
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Country | US
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Telephone |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 002760
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License Number State | CT
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