Provider Demographics
NPI:1497021224
Name:DIELE, REBECCA (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:DIELE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 AMBASSADOR LN
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2906
Mailing Address - Country:US
Mailing Address - Phone:631-320-1379
Mailing Address - Fax:
Practice Address - Street 1:25212 72ND AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2728
Practice Address - Country:US
Practice Address - Phone:718-831-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist