Basic Information
| Provider Information | |||||||||
| NPI: | 1295853182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRISCOLL | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 PECKSUOT RD | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021911611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813378682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021882336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813373121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1298 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.