MEDICARE: MISS DIANA CHRISTINE MOLDENHAUER

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	6671	NC

General Provider Information

NPI Number	:	1164698247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIANA CHRISTINE MOLDENHAUER

Provider Business Mailing Address
First Line	:	7122 BIG HORN DR
Second Line	:
City	:	HILLSBOROUGH
State	:	NC
Zip	:	27278-9748
Country	:	US
Telephone Number	:	919-479-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7122 BIG HORN DR
Second Line	:
City	:	HILLSBOROUGH
State	:	NC
Zip	:	27278-9748
Country	:	US
Telephone Number	:	919-479-9700
Fax Number	:

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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Directions to “ MISS DIANA CHRISTINE MOLDENHAUER ” Practice Location

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