Provider Demographics
NPI:1336473354
Name:SPEARS, DIETRI DIANN (LOT)
Entity Type:Individual
Prefix:
First Name:DIETRI
Middle Name:DIANN
Last Name:SPEARS
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13023 BRYNWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498
Mailing Address - Country:US
Mailing Address - Phone:713-819-1252
Mailing Address - Fax:
Practice Address - Street 1:13023 BRYNWOOD LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7415
Practice Address - Country:US
Practice Address - Phone:713-819-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist