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NPI Code Detail

MEDICARE: DIANE AUSTIN OTR

MEDICARE: DIANE AUSTIN OTR
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
1225X00000XOccupational Therapist5004-26WI

General Provider Information

NPI Number : 1679868400
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE AUSTIN OTR
Provider Business Mailing Address
First Line : 80 1ST ST
Second Line :
City : PRAIRIE DU SAC
State : WI
Zip : 53578-1550
Country : US
Telephone Number : 608-643-7263
Fax Number : 608-643-7667
Provider Business Practice Location Address
First Line : 80 1ST ST
Second Line :
City : PRAIRIE DU SAC
State : WI
Zip : 53578-1550
Country : US
Telephone Number : 608-643-7263
Fax Number : 608-643-7667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2011
Last Update Date : 06/09/2011

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