Provider Demographics
NPI:1649547688
Name:REA, DIANA B (COTA)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:B
Last Name:REA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RICHARD BROWN DR
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1141
Mailing Address - Country:US
Mailing Address - Phone:860-848-8466
Mailing Address - Fax:860-848-7456
Practice Address - Street 1:5 RICHARD BROWN DR
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1141
Practice Address - Country:US
Practice Address - Phone:860-848-8466
Practice Address - Fax:860-848-7456
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00697224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant