Provider Demographics
NPI:1497279947
Name:VANBUSKIRK, DIANE GERALYN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:GERALYN
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:GERALYN
Other - Last Name:NASUTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3131 DANIELS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-7013
Mailing Address - Country:US
Mailing Address - Phone:407-614-0575
Mailing Address - Fax:
Practice Address - Street 1:3131 DANIELS RD STE 106
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-7013
Practice Address - Country:US
Practice Address - Phone:407-614-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
FLOT2403225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics