Provider Demographics
NPI:1750520003
Name:FARRIS, DIANE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:YAGUNICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1200
Mailing Address - Country:US
Mailing Address - Phone:845-729-4260
Mailing Address - Fax:
Practice Address - Street 1:20 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1200
Practice Address - Country:US
Practice Address - Phone:845-729-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005840-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-5332002OtherTAX ID NUMBER