Provider Demographics
NPI:1538715149
Name:LE, DIANA T (OTR/L)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21428 STANWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2252
Mailing Address - Country:US
Mailing Address - Phone:818-626-4937
Mailing Address - Fax:
Practice Address - Street 1:21428 STANWELL ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2252
Practice Address - Country:US
Practice Address - Phone:818-626-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022195-1225X00000X
CAOT18302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist