MEDICARE: MRS. DIANE MICHIE TENGAN HARSCH MS,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	225XH1200X	Hand Occupational Therapist	OT6629	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT0066290	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1497849004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE MICHIE TENGAN HARSCH MS,OTR/L

Provider Business Mailing Address
First Line	:	320 TESCONI CIR
Second Line	:	SUITE G
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4611
Country	:	US
Telephone Number	:	707-538-3178
Fax Number	:	707-544-2088

Provider Business Practice Location Address
First Line	:	320 TESCONI CIR
Second Line	:	SUITE G
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4611
Country	:	US
Telephone Number	:	707-544-2637
Fax Number	:	707-544-2088

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/26/2009

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