Provider Demographics
NPI:1457643934
Name:LUND, DIANA (COTA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LUND
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 1:507 N HIGHWAY 77
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1885
Mailing Address - Country:US
Mailing Address - Phone:972-938-3311
Mailing Address - Fax:972-351-9598
Practice Address - Street 1:507 N HIGHWAY 77
Practice Address - Street 2:SUITE 700
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1885
Practice Address - Country:US
Practice Address - Phone:972-938-3311
Practice Address - Fax:972-351-9598
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208153224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant