Provider Demographics
NPI:1518119916
Name:MILLER, DIANE JEANETTE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JEANETTE
Last Name:MILLER
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 1:600 PRIVATE RD
Mailing Address - Street 2:
Mailing Address - City:WARDENSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26851-8377
Mailing Address - Country:US
Mailing Address - Phone:304-874-3309
Mailing Address - Fax:
Practice Address - Street 1:311 DECATUR ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2416
Practice Address - Country:US
Practice Address - Phone:301-722-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381-0013088Medicaid