Provider Demographics
NPI:1053477422
Name:JONES, DIANE MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962-1105
Mailing Address - Country:US
Mailing Address - Phone:979-725-9041
Mailing Address - Fax:979-725-2185
Practice Address - Street 1:205 EAST AVE STE B
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1646
Practice Address - Country:US
Practice Address - Phone:979-743-4109
Practice Address - Fax:979-743-2185
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102058225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3007OtherBCBS PROVIDER NUMBER