Provider Demographics
NPI:1326197187
Name:BACINO, DIEDRA (OTR)
Entity Type:Individual
Prefix:
First Name:DIEDRA
Middle Name:
Last Name:BACINO
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 1:7701 COPPER MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2686
Mailing Address - Country:US
Mailing Address - Phone:972-795-1021
Mailing Address - Fax:
Practice Address - Street 1:7701 COPPER MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2686
Practice Address - Country:US
Practice Address - Phone:972-795-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist