Provider Demographics
NPI:1639700875
Name:DIAZ, ANALUCIA (OTR)
Entity Type:Individual
Prefix:
First Name:ANALUCIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ANALUCIA
Other - Middle Name:
Other - Last Name:SPEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:46 ST IVES WAY APT 12
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5916
Mailing Address - Country:US
Mailing Address - Phone:915-345-5552
Mailing Address - Fax:
Practice Address - Street 1:548 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2537
Practice Address - Country:US
Practice Address - Phone:915-345-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist