Provider Demographics
NPI:1689942971
Name:DIMINO, CODY DYLAN
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:DYLAN
Last Name:DIMINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:DYLAN
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:855 SPRINGDALE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7361 PRAIRIE FALCON RD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0824
Practice Address - Country:US
Practice Address - Phone:702-804-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11-0142225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics