Provider Demographics
NPI:1184308876
Name:UROT, DIANNE ANGELIC EMBODO
Entity type:Individual
Prefix:
First Name:DIANNE ANGELIC
Middle Name:EMBODO
Last Name:UROT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 DAMRON DR APT 4
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3470
Mailing Address - Country:US
Mailing Address - Phone:304-784-6095
Mailing Address - Fax:
Practice Address - Street 1:26901 US HIGHWAY 119 N
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-7520
Practice Address - Country:US
Practice Address - Phone:606-237-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist