MEDICARE: DR. DIANA MARIE OREM PH.D.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1568777209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA MARIE OREM PH.D.

Provider Business Mailing Address
First Line	:	3850 STRAWBERRY FIELD GRV APT E
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-6302
Country	:	US
Telephone Number	:	407-461-3161
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 BAD TOELZ RD
Second Line	:	10TH SPECIAL FORCES GROUP AIRBORNE
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4626
Country	:	US
Telephone Number	:	710-526-4367
Fax Number	:

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	01/28/2013

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