Provider Demographics
NPI:1336733930
Name:MARIN, DIANE C (OTR)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:MARIN
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 1:10300 S INTERSTATE 35 FRONTAGE RD
Mailing Address - Street 2:APT 2202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:646-474-3241
Mailing Address - Fax:
Practice Address - Street 1:10300 S INTERSTATE 35 FRONTAGE RD
Practice Address - Street 2:APT 2202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-7874
Practice Address - Country:US
Practice Address - Phone:646-474-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist