Provider Demographics
NPI:1104226836
Name:WARZECHA, DIANE (OTR/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WARZECHA
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 1:1650 S AMPHLETT BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2517
Mailing Address - Country:US
Mailing Address - Phone:650-638-9142
Mailing Address - Fax:
Practice Address - Street 1:1650 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2517
Practice Address - Country:US
Practice Address - Phone:650-638-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist