Provider Demographics
NPI:1730221912
Name:KALIK, DIANE L (OTR)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:KALIK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11880 GREENVILLE AVE
Mailing Address - Street 2:STE 100, NORTH TEXAS THERAPY INNOVATIONS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-349-6178
Mailing Address - Fax:214-575-9898
Practice Address - Street 1:11880 GREENVILLE AVE.
Practice Address - Street 2:STE. 100, NORTH TEXAS THERAPY INNOVATIONS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-349-6178
Practice Address - Fax:214-575-9898
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103982174400000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX571156586OtherTAX ID NUMBER