Provider Demographics
NPI:1710210208
Name:BAKER, DIANE ARLENE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ARLENE
Last Name:BAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19341 OTTERS WICK WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7769
Mailing Address - Country:US
Mailing Address - Phone:813-948-4843
Mailing Address - Fax:
Practice Address - Street 1:19341 OTTERS WICK WAY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7769
Practice Address - Country:US
Practice Address - Phone:813-948-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 6810224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant