Provider Demographics
NPI:1598060360
Name:WILLIAMS, DIANA LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8403
Mailing Address - Country:US
Mailing Address - Phone:304-377-1188
Mailing Address - Fax:
Practice Address - Street 1:6 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-8403
Practice Address - Country:US
Practice Address - Phone:304-377-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007598-1224Z00000X
CT1735224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant