Provider Demographics
NPI:1740317114
Name:WELCH, DIANE M (M ED, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:WELCH
Suffix:
Gender:F
Credentials:M ED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PLEASANT ST # U212A
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2030
Mailing Address - Country:US
Mailing Address - Phone:508-481-1541
Mailing Address - Fax:
Practice Address - Street 1:145 PLEASANT ST # U212A
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2030
Practice Address - Country:US
Practice Address - Phone:508-481-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer