Provider Demographics
NPI:1710424007
Name:DIAMOND, KAREN REBECCA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:REBECCA
Last Name:DIAMOND
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 1:6503 N MILITARY TRL
Mailing Address - Street 2:3906
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2698
Mailing Address - Country:US
Mailing Address - Phone:561-414-3939
Mailing Address - Fax:
Practice Address - Street 1:6503 N MILITARY TRL
Practice Address - Street 2:3906
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2698
Practice Address - Country:US
Practice Address - Phone:561-414-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist