Provider Demographics
NPI:1770702797
Name:RENDE DALLAS, DIANA LYNN (MOT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:RENDE DALLAS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5215
Mailing Address - Country:US
Mailing Address - Phone:206-378-6342
Mailing Address - Fax:
Practice Address - Street 1:1119 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5215
Practice Address - Country:US
Practice Address - Phone:206-691-2598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004459225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics