Provider Demographics
NPI:1063922052
Name:DIEDEL, MARINA (COTA/L)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:DIEDEL
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 1:35933 LIFE CT UNIT 204
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-2464
Mailing Address - Country:US
Mailing Address - Phone:913-378-3876
Mailing Address - Fax:
Practice Address - Street 1:7350 DAIRY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1354
Practice Address - Country:US
Practice Address - Phone:813-788-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13555224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant