Provider Demographics
NPI:1801322391
Name:MASTROIANNI, DIANE (OT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MASTROIANNI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 LOWER HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-9739
Mailing Address - Country:US
Mailing Address - Phone:413-267-5326
Mailing Address - Fax:
Practice Address - Street 1:434 LOWER HAMPDEN RD
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:MA
Practice Address - Zip Code:01057-9739
Practice Address - Country:US
Practice Address - Phone:413-267-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist