Provider Demographics
NPI:1902964786
Name:MACAULAY-KOEHN, DIANA ROWLAND (OT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ROWLAND
Last Name:MACAULAY-KOEHN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3541
Mailing Address - Country:US
Mailing Address - Phone:410-905-9378
Mailing Address - Fax:240-264-6156
Practice Address - Street 1:11621 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUNRISE OF SILVER SPRING
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2731
Practice Address - Country:US
Practice Address - Phone:410-905-9378
Practice Address - Fax:240-264-6156
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02836225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02836OtherOTR