Provider Demographics
NPI:1568004497
Name:SCARBOROUGH, DIANA LYNNE (OTR)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6135
Mailing Address - Country:US
Mailing Address - Phone:208-346-2991
Mailing Address - Fax:
Practice Address - Street 1:3615 SPICER DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-7043
Practice Address - Country:US
Practice Address - Phone:541-967-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT1909225X00000X
OR404050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist