Provider Demographics
NPI:1457487555
Name:HALLER, DIANE J (OTR)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:HALLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27637 HINERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:KS
Mailing Address - Zip Code:66401
Mailing Address - Country:US
Mailing Address - Phone:785-765-3855
Mailing Address - Fax:
Practice Address - Street 1:1610 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611
Practice Address - Country:US
Practice Address - Phone:785-267-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist