MEDICARE: MRS. DIANE LYNN BROCATO OCCUPATIONAL THERAPI

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	107951	TX

General Provider Information

NPI Number	:	1174607469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE LYNN BROCATO OCCUPATIONAL THERAPI

Provider Business Mailing Address
First Line	:	19810 OAK GREEN CT
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-1273
Country	:	US
Telephone Number	:	281-812-4170
Fax Number	:	281-459-9136

Provider Business Practice Location Address
First Line	:	5810 E SAM HOUSTON PKWY N STE K
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2528
Country	:	US
Telephone Number	:	281-459-9134
Fax Number	:	281-459-9136

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/24/2015

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