Provider Demographics
NPI:1437664877
Name:DIENER, PATRICIA ANNE (MS, OTRL)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:DIENER
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MENASHA TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1224
Mailing Address - Country:US
Mailing Address - Phone:248-568-3448
Mailing Address - Fax:
Practice Address - Street 1:128 MENASHA TRL
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-1224
Practice Address - Country:US
Practice Address - Phone:248-568-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist