Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC017350 | PA |
NPI | 1083210900 |
---|---|
Provider Name | Abigail E Diciano |
First Address | Denver, PA 17517-1721 |
Second Address | Denver, PA 17517-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2020 |
Last Update Date | 07/12/2020 |