Provider Demographics
NPI:1508931577
Name:SEPULVADO, DIANNE LYNN (OT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYNN
Last Name:SEPULVADO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:LYNN
Other - Last Name:WADDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2103 S SHADOW GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2427
Mailing Address - Country:US
Mailing Address - Phone:832-595-0361
Mailing Address - Fax:
Practice Address - Street 1:2200 SOUTHWEST FWY
Practice Address - Street 2:STE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4710
Practice Address - Country:US
Practice Address - Phone:713-526-6143
Practice Address - Fax:713-527-8215
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist