Provider Demographics
NPI:1598332181
Name:DESILETS, DIANE MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DESILETS
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:OT TO PLAY
Mailing Address - Street 2:18 GROVE STREET
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04266
Mailing Address - Country:US
Mailing Address - Phone:207-739-2242
Mailing Address - Fax:
Practice Address - Street 1:OT TO PLAY
Practice Address - Street 2:18 GROVE STREET
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04266
Practice Address - Country:US
Practice Address - Phone:207-739-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist