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NPI Code Detail

MEDICARE: MRS. DIANE MARIE REID-VAN ASDALE OTR/L, CHT

MEDICARE: MRS. DIANE MARIE REID-VAN ASDALE OTR/L, CHT
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 TherapistOT3166FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT3166OTHERFLLICENSE#

General Provider Information

NPI Number : 1912077744
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE MARIE REID-VAN ASDALE OTR/L, CHT
Provider Business Mailing Address
First Line : 160 WARING WAY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32952-6213
Country : US
Telephone Number : 321-449-0590
Fax Number :
Provider Business Practice Location Address
First Line : 150 N SYKES CREEK PKWY STE 103
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-3488
Country : US
Telephone Number : 321-459-0303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 01/19/2026

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