MEDICARE: DIANE LEDFORD

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	224Z00000X	Occupational Therapy Assistant	570	NC

General Provider Information

NPI Number	:	1124216957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE LEDFORD

Provider Business Mailing Address
First Line	:	104 DUDLEY AVE
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28630-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 DUDLEY AVE
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28630-1238
Country	:	US
Telephone Number	:	828-754-8500
Fax Number	:

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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