MEDICARE: MS. GLORIA M. DIAZ-RAMOS 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	174400000X	Specialist	OT1258	TN

General Provider Information

NPI Number	:	1528068038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA M. DIAZ-RAMOS OTR/L

Provider Business Mailing Address
First Line	:	4137 CALLIE POWELL CV
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-1645
Country	:	US
Telephone Number	:	901-438-7162
Fax Number	:

Provider Business Practice Location Address
First Line	:	4137 CALLIE POWELL CV
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-1645
Country	:	US
Telephone Number	:	901-438-7162
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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