Provider Demographics
NPI:1093128274
Name:CERULLI, DIANE MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:CERULLI
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 1:919 DONCASTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-1911
Mailing Address - Country:US
Mailing Address - Phone:856-383-9944
Mailing Address - Fax:
Practice Address - Street 1:919 DONCASTER DR
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08066-1911
Practice Address - Country:US
Practice Address - Phone:856-383-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist