Provider Demographics
NPI:1760685408
Name:CROOM ATKINS, DIANA MARY (OTD OTR)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARY
Last Name:CROOM ATKINS
Suffix:
Gender:F
Credentials:OTD OTR
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARY
Other - Last Name:CROOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR
Mailing Address - Street 1:3019 SW 27TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1827
Mailing Address - Country:US
Mailing Address - Phone:352-275-5778
Mailing Address - Fax:
Practice Address - Street 1:3019 SW 27TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1826
Practice Address - Country:US
Practice Address - Phone:352-275-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-7384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8905649Medicaid