Provider Demographics
NPI:1780703199
Name:PERSUN, DIANNA KAY (OTR)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:KAY
Last Name:PERSUN
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 1:1073 N BRYANT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3667
Mailing Address - Country:US
Mailing Address - Phone:405-923-9672
Mailing Address - Fax:800-680-9132
Practice Address - Street 1:1073 N BRYANT
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3667
Practice Address - Country:US
Practice Address - Phone:405-923-9672
Practice Address - Fax:800-680-9132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOT866OtherOCCUPATIONAL THERAPIST
OK200128980AMedicaid