Provider Demographics
NPI:1700030897
Name:KING, DIANNE ELAINE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:ELAINE
Last Name:KING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 E COUNTY ROAD 300 S
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-9604
Mailing Address - Country:US
Mailing Address - Phone:317-839-7435
Mailing Address - Fax:317-331-1074
Practice Address - Street 1:8580 E COUNTY ROAD 300 S
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-9604
Practice Address - Country:US
Practice Address - Phone:317-839-7435
Practice Address - Fax:317-331-1074
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000363A225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology