Provider Demographics
NPI:1568683415
Name:MCDANIEL, DIANE STARR (RPT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:STARR
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 JAMESTOWN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6135
Mailing Address - Country:US
Mailing Address - Phone:405-359-7091
Mailing Address - Fax:
Practice Address - Street 1:901 N PORTER
Practice Address - Street 2:NORMAN REGIONAL HOSPITAL
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73070
Practice Address - Country:US
Practice Address - Phone:405-307-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist