Provider Demographics
NPI:1568854503
Name:MAKOVSKY, DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MAKOVSKY
Suffix:
Gender:F
Credentials: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:PO BOX 589
Mailing Address - Street 2:CARLISLE
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-0589
Mailing Address - Country:US
Mailing Address - Phone:650-678-3791
Mailing Address - Fax:
Practice Address - Street 1:38 LITCHFIELD DR
Practice Address - Street 2:CARLISLE
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1140
Practice Address - Country:US
Practice Address - Phone:650-678-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA312494225X00000X
CA13529225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist