Provider Demographics
NPI:1811269988
Name:MCANALLY, DIANA L (OTR1541)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:MCANALLY
Suffix:
Gender:F
Credentials:OTR1541
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:WORKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR1541
Mailing Address - Street 1:P.O. BOX 13525
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-0525
Mailing Address - Country:US
Mailing Address - Phone:501-804-2304
Mailing Address - Fax:501-851-1137
Practice Address - Street 1:401 SOUTHRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-8853
Practice Address - Country:US
Practice Address - Phone:501-804-2304
Practice Address - Fax:501-851-1137
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist