Provider Demographics
NPI:1609324391
Name:DIEHL, MARY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DIEHL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11607 POND COVE RD SW
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:21543-2033
Mailing Address - Country:US
Mailing Address - Phone:301-759-2757
Mailing Address - Fax:
Practice Address - Street 1:730 FURNACE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1564
Practice Address - Country:US
Practice Address - Phone:301-759-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07969225XP0200X, 225X00000X
WV1842225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics