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General NPI Number Information
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NPI Number | 1902295256
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Entity Type | Individual
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Provider Name | DIANA MORAN
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Gender | Female
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 20 OLESEN RD
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City | DERRY
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State | NH
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Zip | 03038-4846
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Country | US
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Telephone | 617-504-6346
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Fax |
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Provider Business Mailing Address
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Address Line | 90 OUTLOOK RD
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City | WAKEFIELD
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State | MA
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Zip | 01880-1453
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 3561
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License Number State | MA
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