Provider Demographics
NPI:1912214826
Name:DIAZ, LUZ LEIDA (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:LUZ LEIDA
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 1:325 MARINE AVE
Mailing Address - Street 2:APT D-9
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8054
Mailing Address - Country:US
Mailing Address - Phone:718-710-2911
Mailing Address - Fax:
Practice Address - Street 1:8804 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5902
Practice Address - Country:US
Practice Address - Phone:718-238-7451
Practice Address - Fax:718-238-3765
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002591225X00000X
NY002591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist