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NPI Code Detail

MEDICARE: MS. DIANE GARRETT-KINGS

MEDICARE:  MS. DIANE  GARRETT-KINGS
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1689853566
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANE GARRETT-KINGS
Provider Business Mailing Address
First Line : 3937 W LEXINGTON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60624-3649
Country : US
Telephone Number : 773-910-5338
Fax Number :
Provider Business Practice Location Address
First Line : 3937 W LEXINGTON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60624-3649
Country : US
Telephone Number : 773-910-5338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2007
Last Update Date : 10/29/2007

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Directions to “ MS. DIANE GARRETT-KINGS ” Practice Location

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