Provider Demographics
NPI:1023141561
Name:MUSSER, DIANE (OTR)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MUSSER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 N WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1040
Mailing Address - Country:US
Mailing Address - Phone:608-831-8628
Mailing Address - Fax:
Practice Address - Street 1:1234 N WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1040
Practice Address - Country:US
Practice Address - Phone:608-831-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2953026174400000X
WI2953-026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40853600Medicare ID - Type Unspecified