Provider Demographics
NPI:1245440627
Name:HINMAN-GUGGOLZ, DIANE VIRGINIA
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:VIRGINIA
Last Name:HINMAN-GUGGOLZ
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 1:204 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2413
Mailing Address - Country:US
Mailing Address - Phone:860-423-9698
Mailing Address - Fax:
Practice Address - Street 1:595 VALLEY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1901
Practice Address - Country:US
Practice Address - Phone:860-450-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist