Provider Demographics
NPI:1255922712
Name:MCCRAY-BROWN, DIANE (OTA/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MCCRAY-BROWN
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MCCRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2303 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1511
Mailing Address - Country:US
Mailing Address - Phone:863-307-2739
Mailing Address - Fax:
Practice Address - Street 1:501 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3335
Practice Address - Country:US
Practice Address - Phone:863-679-3338
Practice Address - Fax:863-455-7049
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant