=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770002008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE MICHELLE COLLING COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 09/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1502 FREDERICK RD
-----------------------------------------------------
City | CATONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-747-3287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7474 CATTERICK CT
-----------------------------------------------------
City | WINDSOR MILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21244-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | A01517
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------