Provider Demographics
NPI:1841286218
Name:DAVIS, DIANNE R (OT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:R
Other - Last Name:ZOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3219 W RALPH ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5043
Mailing Address - Country:US
Mailing Address - Phone:605-360-1714
Mailing Address - Fax:
Practice Address - Street 1:3219 W RALPH ROGERS RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5043
Practice Address - Country:US
Practice Address - Phone:605-360-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0356225X00000X
MN103118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist