Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT - 2753 | OH |
NPI | 1104360494 |
---|---|
Provider Name | Diane Loughren |
First Address | Oberlin, OH 44074-1900 |
Second Address | Oberlin, OH 44074-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2016 |
Last Update Date | 06/12/2016 |