Provider Demographics
NPI:1760549968
Name:LIPPERT, DIANE MARIE (OTR-L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LIPPERT
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 1:801 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3649
Mailing Address - Country:US
Mailing Address - Phone:701-662-7690
Mailing Address - Fax:701-662-7684
Practice Address - Street 1:801 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3649
Practice Address - Country:US
Practice Address - Phone:701-662-7690
Practice Address - Fax:701-662-7684
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND95225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND59068Medicaid