Provider Demographics
NPI:1952457590
Name:OCONNELL, DIANE M (RPT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 QUIET ST
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1085
Mailing Address - Country:US
Mailing Address - Phone:508-888-4620
Mailing Address - Fax:
Practice Address - Street 1:130 ANSEL HALLET RD
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2582
Practice Address - Country:US
Practice Address - Phone:508-771-1300
Practice Address - Fax:508-771-3425
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist