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General NPI Number Information
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NPI Number | 1750102901
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Entity Type | Individual
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Provider Name | DIANA PREDA OTR
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 29751 LITTLE MACK AVE STE A
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City | ROSEVILLE
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State | MI
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Zip | 48066-6504
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Country | US
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Telephone | 313-278-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 KENTFIELD DR
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City | ROCHESTER
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State | MI
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Zip | 48307-6050
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Country | US
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Telephone | 586-208-5664
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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 | 5201013862
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201013862
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License Number State | MI
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