Provider Demographics
NPI:1497849004
Name:HARSCH, DIANE MICHIE TENGAN (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MICHIE TENGAN
Last Name:HARSCH
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 1:320 TESCONI CIR
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4611
Mailing Address - Country:US
Mailing Address - Phone:707-538-3178
Mailing Address - Fax:707-544-2088
Practice Address - Street 1:320 TESCONI CIR
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4611
Practice Address - Country:US
Practice Address - Phone:707-544-2637
Practice Address - Fax:707-544-2088
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6629225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0066290OtherBLUE SHIELD
CAZZZ04557ZMedicare PIN