Provider Demographics
NPI:1760765895
Name:AYERS, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E WASHINGTON ST
Mailing Address - Street 2:APT. 202
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8455 COUNTY ROUTE 125
Practice Address - Street 2:BOCES OFFICE
Practice Address - City:CAMPBELL
Practice Address - State:NY
Practice Address - Zip Code:14821-9518
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006786-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist