Provider Demographics
NPI:1174865828
Name:TOREN, DIANE M (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:TOREN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 211TH PL
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1409
Mailing Address - Country:US
Mailing Address - Phone:219-322-2076
Mailing Address - Fax:
Practice Address - Street 1:641 211TH PL
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1409
Practice Address - Country:US
Practice Address - Phone:219-322-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057000366224Z00000X
IN32000102A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant