Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00002553 | CO |
NPI | 1003047655 |
---|---|
Provider Name | Diane K O'neil |
First Address | Alamosa, CO 81101-2156 |
Second Address | Alamosa, CO 81101-2156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 29/11/2016 |