Provider Demographics
NPI:1801227590
Name:DIAZ, CARMEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:DIAZ
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 1:2500 N VAN DORN ST
Mailing Address - Street 2:APT. 119
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1626
Mailing Address - Country:US
Mailing Address - Phone:571-255-0103
Mailing Address - Fax:703-543-2340
Practice Address - Street 1:2500 N VAN DORN ST
Practice Address - Street 2:APT. 119
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1626
Practice Address - Country:US
Practice Address - Phone:571-255-0103
Practice Address - Fax:703-543-2340
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000932225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist