Provider Demographics
NPI:1952727869
Name:CARROLL, DIANE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MACSAVENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 BEACH 216TH ST.
Mailing Address - Street 2:
Mailing Address - City:BREEZY PT.
Mailing Address - State:NY
Mailing Address - Zip Code:11697
Mailing Address - Country:US
Mailing Address - Phone:347-752-2426
Mailing Address - Fax:
Practice Address - Street 1:76 BEACH 216TH ST
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1509
Practice Address - Country:US
Practice Address - Phone:347-752-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018671225X00000X
NY018671-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist