Provider Demographics
NPI:1679046676
Name:MOROCHO, DIEGO (OTA)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:MOROCHO
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 87TH ST APT 3H
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5605
Mailing Address - Country:US
Mailing Address - Phone:718-607-1426
Mailing Address - Fax:
Practice Address - Street 1:8608 57TH RD APT 3R
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4874
Practice Address - Country:US
Practice Address - Phone:718-607-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007608224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant