Provider Demographics
NPI:1982258299
Name:ZARNDT BUETTNER, DIANNA MICHELLE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:MICHELLE
Last Name:ZARNDT BUETTNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1812
Mailing Address - Country:US
Mailing Address - Phone:847-452-8819
Mailing Address - Fax:
Practice Address - Street 1:405 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1812
Practice Address - Country:US
Practice Address - Phone:847-452-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant