Provider Demographics
NPI:1760648133
Name:DOUBLEDAY, DIANE C (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:DOUBLEDAY
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 1:10611 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-4434
Mailing Address - Country:US
Mailing Address - Phone:802-457-3365
Mailing Address - Fax:
Practice Address - Street 1:223 S WINDSOR ST
Practice Address - Street 2:
Practice Address - City:SOUTH ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068-9625
Practice Address - Country:US
Practice Address - Phone:802-763-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist