Provider Demographics
NPI:1164698247
Name:MOLDENHAUER, DIANA CHRISTINE
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:CHRISTINE
Last Name:MOLDENHAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 BIG HORN DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9748
Mailing Address - Country:US
Mailing Address - Phone:919-479-9700
Mailing Address - Fax:
Practice Address - Street 1:7122 BIG HORN DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9748
Practice Address - Country:US
Practice Address - Phone:919-479-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6671224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant