Provider Demographics
NPI:1104051366
Name:KLINE, DIANE MARIE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:KLINE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 WICKFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4741
Mailing Address - Country:US
Mailing Address - Phone:610-247-4545
Mailing Address - Fax:610-449-5906
Practice Address - Street 1:218 WICKFORD ROAD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4741
Practice Address - Country:US
Practice Address - Phone:610-247-4545
Practice Address - Fax:610-449-5906
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002300L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist