Provider Demographics
NPI:1003900176
Name:DIEZ, LUISA (ROT)
Entity Type:Individual
Prefix:MS
First Name:LUISA
Middle Name:
Last Name:DIEZ
Suffix:
Gender:F
Credentials:ROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E 84TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6484
Mailing Address - Country:US
Mailing Address - Phone:219-756-7246
Mailing Address - Fax:219-736-5856
Practice Address - Street 1:399 E 84TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6484
Practice Address - Country:US
Practice Address - Phone:219-756-7246
Practice Address - Fax:219-736-5856
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001828A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN137690Medicare ID - Type Unspecified