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NPI Code Detail

MEDICARE: DYANNE ESTELLE VAN PETER OT/L

MEDICARE:   DYANNE ESTELLE VAN PETER  OT/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
1225XP0200XPediatric Occupational Therapist3077CA

General Provider Information

NPI Number : 1376080036
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYANNE ESTELLE VAN PETER OT/L
Provider Business Mailing Address
First Line : 77564 COUNTRY CLUB DR STE 340
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-0450
Country : US
Telephone Number : 760-772-2838
Fax Number : 760-772-2838
Provider Business Practice Location Address
First Line : 77564 COUNTRY CLUB DR STE 340
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-0450
Country : US
Telephone Number : 760-772-2838
Fax Number : 760-772-2838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2017
Last Update Date : 10/20/2020

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Directions to “ DYANNE ESTELLE VAN PETER OT/L” Practice Location

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