Provider Demographics
NPI:1386002137
Name:CAMILO, DIANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CAMILO
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 1:50 W 192ND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4106
Mailing Address - Country:US
Mailing Address - Phone:917-930-7022
Mailing Address - Fax:
Practice Address - Street 1:50 W 192ND ST APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4106
Practice Address - Country:US
Practice Address - Phone:917-930-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63020306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist