Provider Demographics
NPI:1619119229
Name:PUCHERO, DIANNA LINDA APOSTOL (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANNA LINDA
Middle Name:APOSTOL
Last Name:PUCHERO
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 1:7620 GREENBORO DR
Mailing Address - Street 2:APARTMENT # 2
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1403
Mailing Address - Country:US
Mailing Address - Phone:321-327-3791
Mailing Address - Fax:
Practice Address - Street 1:7201 GREENBORO DR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1698
Practice Address - Country:US
Practice Address - Phone:321-727-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0T13166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist