Provider Demographics
NPI:1861777492
Name:DEVANZO, DIANNE MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:DEVANZO
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 1:6 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7608
Mailing Address - Country:US
Mailing Address - Phone:845-357-7917
Mailing Address - Fax:
Practice Address - Street 1:6 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-7608
Practice Address - Country:US
Practice Address - Phone:845-357-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004646-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist