Provider Demographics
NPI:1417285305
Name:PEDRAZA, DIANA M (OTR)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:SCOTT-PEDRAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:1618 CHIHUAHUA ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3601
Mailing Address - Country:US
Mailing Address - Phone:866-796-0556
Mailing Address - Fax:
Practice Address - Street 1:1618 CHIHUAHUA ST STE B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3601
Practice Address - Country:US
Practice Address - Phone:866-796-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist