Provider Demographics
NPI:1356501498
Name:OTTOLENGHI, DIANE (LMT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:OTTOLENGHI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:OTTOLENGHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1755 LEXVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2915
Mailing Address - Country:US
Mailing Address - Phone:567-303-2213
Mailing Address - Fax:
Practice Address - Street 1:1755 LEXVIEW CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2915
Practice Address - Country:US
Practice Address - Phone:567-303-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700815101YM0800X
OH33.004543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health