Provider Demographics
NPI:1013039031
Name:CLARKE, DIANA MARIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIE
Last Name:CLARKE
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 1:1463 KINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVALE
Mailing Address - State:TN
Mailing Address - Zip Code:37153-4078
Mailing Address - Country:US
Mailing Address - Phone:615-907-8008
Mailing Address - Fax:
Practice Address - Street 1:420 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3931
Practice Address - Country:US
Practice Address - Phone:615-893-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1033224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant