Provider Demographics
NPI:1083994669
Name:FLEMING, DIANNA M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:M
Last Name:FLEMING
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 1:8 PARK CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2522
Mailing Address - Country:US
Mailing Address - Phone:585-223-0918
Mailing Address - Fax:
Practice Address - Street 1:2034 LEHIGH STATION RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9616
Practice Address - Country:US
Practice Address - Phone:585-359-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008567-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497492Medicaid