Provider Demographics
NPI:1033410915
Name:MEDINA, DIANNA MICHELLE (MOT)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:MICHELLE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 CHIHUAHUA ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5247
Mailing Address - Country:US
Mailing Address - Phone:956-723-3737
Mailing Address - Fax:956-723-3736
Practice Address - Street 1:719 CHIHUAHUA ST
Practice Address - Street 2:SUITE 107
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5247
Practice Address - Country:US
Practice Address - Phone:956-723-3737
Practice Address - Fax:956-723-3736
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist