Provider Demographics
NPI:1730583014
Name:MACKINTOSH, DIANE (MA OTR/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MACKINTOSH
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2046
Mailing Address - Country:US
Mailing Address - Phone:774-551-6003
Mailing Address - Fax:
Practice Address - Street 1:118 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2046
Practice Address - Country:US
Practice Address - Phone:774-551-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01342225X00000X
MA10719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist