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General NPI Number Information
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NPI Number | 1881138519
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Entity Type | Individual
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Provider Name | DIANNE JEZAK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 16 LONDONDERRY RD
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City | WINDHAM
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State | NH
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Zip | 03087-1651
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Country | US
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Telephone | 603-434-8015
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Fax |
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Provider Business Mailing Address
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Address Line | 16 LONDONDERRY RD
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City | WINDHAM
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State | NH
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Zip | 03087-1651
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Country | US
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Telephone | 603-434-8015
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1551M
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License Number State | NH
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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 | 1303
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3854
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License Number State | MA
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