Provider Demographics
NPI:1417177080
Name:GARCIA, DIANE C (COTA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:GARCIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18216 W SAN JUAN CT
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-8383
Mailing Address - Country:US
Mailing Address - Phone:480-307-2173
Mailing Address - Fax:602-305-7880
Practice Address - Street 1:2614 W APOLLO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5339
Practice Address - Country:US
Practice Address - Phone:520-271-6809
Practice Address - Fax:602-305-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1536224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant