Provider Demographics
NPI:1134423395
Name:SMOOKE, DIANE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SMOOKE
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 1:223 CORNFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-9750
Mailing Address - Country:US
Mailing Address - Phone:717-248-3579
Mailing Address - Fax:
Practice Address - Street 1:2 MANOR BLVD
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-8757
Practice Address - Country:US
Practice Address - Phone:717-436-2178
Practice Address - Fax:717-436-6806
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002407L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist