Provider Demographics
NPI:1902026453
Name:KIRKWOOD, DIANE M
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:KIRKWOOD
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 1:14434 W 88TH DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-1255
Mailing Address - Country:US
Mailing Address - Phone:720-273-5895
Mailing Address - Fax:
Practice Address - Street 1:14434 W 88TH DR UNIT D
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1255
Practice Address - Country:US
Practice Address - Phone:720-273-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24082228Medicaid