MEDICARE: ROCHELLE DIAMOND 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	225X00000X	Occupational Therapist	011891-1	NY

General Provider Information

NPI Number	:	1811133606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCHELLE DIAMOND OTR/L

Provider Business Mailing Address
First Line	:	1364 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5311
Country	:	US
Telephone Number	:	917-445-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5311
Country	:	US
Telephone Number	:	917-445-0508
Fax Number	:

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

Provider Enumeration Date	:	12/28/2008
Last Update Date	:	12/28/2008

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