Provider Demographics
NPI:1780885558
Name:PATTERSON, DIANA LYNN (COTA)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 LOWER MARINE RD
Mailing Address - Street 2:
Mailing Address - City:MARINE
Mailing Address - State:IL
Mailing Address - Zip Code:62061-2008
Mailing Address - Country:US
Mailing Address - Phone:618-644-9341
Mailing Address - Fax:
Practice Address - Street 1:6740 BEACH RESORT DR APT 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-7558
Practice Address - Country:US
Practice Address - Phone:618-581-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 10260224Z00000X
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant