Provider Demographics
NPI:1891946745
Name:PARTAIN, DIANA LYNN (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:PARTAIN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 E KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2013
Mailing Address - Country:US
Mailing Address - Phone:480-668-8742
Mailing Address - Fax:
Practice Address - Street 1:1414 W BROADWAY RD
Practice Address - Street 2:SUITE 218
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1133
Practice Address - Country:US
Practice Address - Phone:480-449-3331
Practice Address - Fax:480-753-9428
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2849225X00000X
AZ7268225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2849OtherOT LICENSE