Provider Demographics
NPI:1205160363
Name:BEEBE ZECCOLA, DIANE LATIMER (OTR)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LATIMER
Last Name:BEEBE ZECCOLA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RIVERWIND DR
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1222
Mailing Address - Country:US
Mailing Address - Phone:518-399-2423
Mailing Address - Fax:
Practice Address - Street 1:34 RIVERWIND DR
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1222
Practice Address - Country:US
Practice Address - Phone:518-399-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001336-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics