Provider Demographics
NPI:1821283128
Name:GARZA, DIANA ISABEL (OT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ISABEL
Last Name:GARZA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODBINE PL UNIT 775
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-2912
Mailing Address - Country:US
Mailing Address - Phone:903-757-8194
Mailing Address - Fax:903-757-8294
Practice Address - Street 1:107 WOODBINE PL UNIT 775
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-2912
Practice Address - Country:US
Practice Address - Phone:903-757-8194
Practice Address - Fax:903-757-8294
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109856225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210886201Medicaid
TX0217382-01Medicaid
TX210886201Medicaid