Provider Demographics
NPI:1235301557
Name:TERAN, DIANA MARCELA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARCELA
Last Name:TERAN
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 1:7231 MIAMI LAKES DR APT C17
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6943
Mailing Address - Country:US
Mailing Address - Phone:786-399-4453
Mailing Address - Fax:
Practice Address - Street 1:7231 MIAMI LAKES DR APT C17
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6943
Practice Address - Country:US
Practice Address - Phone:786-399-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist