MEDICARE: JODI DIETZ OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	122604	TX

General Provider Information

NPI Number	:	1063852549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI DIETZ OTR/L

Provider Business Mailing Address
First Line	:	416 TURKEY CREEK DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-1901
Country	:	US
Telephone Number	:	561-504-4653
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 W LEBANON STE 316
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-3415
Country	:	US
Telephone Number	:	817-479-7019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	02/18/2023

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Directions to “ JODI DIETZ OTR/L” Practice Location

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