Provider Demographics
NPI:1568594117
Name:GROSS-GIESE, DIANNE (OTRL,CHT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:GROSS-GIESE
Suffix:
Gender:F
Credentials:OTRL,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NEW WINE PL
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4008
Mailing Address - Country:US
Mailing Address - Phone:805-434-9011
Mailing Address - Fax:
Practice Address - Street 1:1051 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5603
Practice Address - Country:US
Practice Address - Phone:805-434-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5179225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand