Provider Demographics
NPI:1124353495
Name:KOSINSKI-HEDRICK, DIANA LYNN (LMT)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:KOSINSKI-HEDRICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 NW 3RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1757
Mailing Address - Country:US
Mailing Address - Phone:541-447-7230
Mailing Address - Fax:541-447-7577
Practice Address - Street 1:446 NW 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1757
Practice Address - Country:US
Practice Address - Phone:541-447-7230
Practice Address - Fax:541-447-7577
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist