Provider Demographics
NPI:1972889020
Name:OSBORNE, DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:OSBORNE
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 1:9511 WHITE CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6721
Mailing Address - Country:US
Mailing Address - Phone:919-818-3155
Mailing Address - Fax:
Practice Address - Street 1:9511 WHITE CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6721
Practice Address - Country:US
Practice Address - Phone:919-818-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation