Provider Demographics
NPI:1003000605
Name:FREEMAN, DIANE ELIZABETH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:DEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:9010 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48632-8800
Mailing Address - Country:US
Mailing Address - Phone:810-252-1932
Mailing Address - Fax:
Practice Address - Street 1:3058 N STATE RD STE E
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-3508
Practice Address - Country:US
Practice Address - Phone:810-652-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003946225XN1300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No174400000XOther Service ProvidersSpecialist