Provider Demographics
NPI:1073805560
Name:DIEKER, MARIAH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:
Last Name:DIEKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 QUARTER CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3002
Mailing Address - Country:US
Mailing Address - Phone:719-237-9556
Mailing Address - Fax:
Practice Address - Street 1:5755 MARK DABLING BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2228
Practice Address - Country:US
Practice Address - Phone:719-630-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist