Mrs. Diane Jean Mccormack
Occupational Therapist - Pediatrics
15840 Long Lake Road
Detroit Lakes
, Minnesota 56501
Mrs. Diane Jean Mccormack
Occupational Therapist - Pediatrics
15840 Long Lake Road
Detroit Lakes
, Minnesota 56501
(218) 234-1302
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About
Features
Specialties
- Occupational Therapist - Pediatrics
Languages spoken
- English
Location
First Address
- Mrs. Diane Jean Mccormack
- P.o. Box 1382
- Detroit Lakes, MN
- Zip : 56502
- Phone : (218) 234-1302
Second Address
- Mrs. Diane Jean Mccormack
- 15840 Long Lake Road
- Detroit Lakes, MN
- Zip : 56501
- Phone : (218) 847-5071
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225XP0200X | Occupational Therapist - Pediatrics | 100296 | MN |
National Provider Identifier
| NPI | 1063657120 |
|---|---|
| Provider Name | Mrs. Diane Jean Mccormack |
| First Address | Detroit Lakes, MN 56502 |
| Second Address | Detroit Lakes, MN 56501 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/12/2008 |
| Last Update Date | 03/12/2008 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.