Basic Information
Provider Information
NPI: 1891026043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIOS
FirstName: DIANNE
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: SCD, OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: TERHUNE
OtherFirstName: DIANNE
OtherMiddleName: C.
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 2445 140TH AVE NE STE B105
Address2:  
City: BELLEVUE
State: WA
PostalCode: 980051879
CountryCode: US
TelephoneNumber: 4256446328
FaxNumber: 4256446295
Practice Location
Address1: 2445 140TH AVE NE STE B105
Address2:  
City: BELLEVUE
State: WA
PostalCode: 980051879
CountryCode: US
TelephoneNumber: 4256446328
FaxNumber: 4256446295
Other Information
ProviderEnumerationDate: 01/27/2010
LastUpdateDate: 02/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT 60079513WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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