Provider Demographics
NPI:1912248857
Name:RISTY, DIANA LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYN
Last Name:RISTY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYN
Other - Last Name:HUETTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12161 386TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:SD
Mailing Address - Zip Code:57481-6915
Mailing Address - Country:US
Mailing Address - Phone:605-216-7170
Mailing Address - Fax:
Practice Address - Street 1:1002 N JAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2439
Practice Address - Country:US
Practice Address - Phone:605-622-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist