Provider Demographics
NPI:1659559847
Name:SOLOMON, DIANE R (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:SOLOMON
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 1:148 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-9765
Mailing Address - Country:US
Mailing Address - Phone:802-479-3638
Mailing Address - Fax:
Practice Address - Street 1:148 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-9765
Practice Address - Country:US
Practice Address - Phone:802-479-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000337225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics