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NPI Code Detail

MEDICARE: DIANNE L REID OTR / L

MEDICARE: DIANNE L REID 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
1225X00000XOccupational Therapist100066MN

General Provider Information

NPI Number : 1811080369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE L REID OTR / L
Provider Business Mailing Address
First Line : 15125 64TH AVE N
Second Line :
City : MAPLE GROVE
State : MN
Zip : 55311-4315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3395 PLYMOUTH RD
Second Line :
City : MINNETONKA
State : MN
Zip : 55305-3765
Country : US
Telephone Number : 952-939-0396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 12/11/2018

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Directions to “ DIANNE L REID OTR / L” Practice Location

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