Basic Information
| Provider Information | |||||||||
| NPI: | 1992749162 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDERSON | ||||||||
| FirstName: | DIANE | ||||||||
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| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE STREET SE | ||||||||
| Address2: | MMC 388 UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126252661 | ||||||||
| FaxNumber: | 6126246686 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 OAK STREET S.E. MCNAMARA ALUMNI CENTER | ||||||||
| Address2: | SUITE 160 UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126265645 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 101023 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3401887 | 05 | MT | MEDICAID | 64-05886 | 01 | MN | MEDICA CHOICE & PRIMARY | OTHER | 2388748 | 01 | MN | ARAZ | OTHER | 700T9AN | 01 | MN | BCBS | OTHER | 1029526 | 01 | MN | PREFERRED ONE | OTHER | 40897100 | 05 | WI | MEDICAID | B677 | 01 | MN | CHAMPUS/TRIWEST | OTHER | HP56993 | 01 | MN | HEALTHPARTNERS | OTHER |