Provider Demographics
NPI:1891276192
Name:DIEDRICH, DEVIN MARY (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:MARY
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E ALAMEDA AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2699
Mailing Address - Country:US
Mailing Address - Phone:307-299-2002
Mailing Address - Fax:
Practice Address - Street 1:11960 LIONESS WAY STE 240
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5644
Practice Address - Country:US
Practice Address - Phone:720-243-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist