Provider Demographics
NPI:1194720474
Name:COKER, DIANE J (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:COKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:AUTREY
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 31063
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92654-1063
Mailing Address - Country:US
Mailing Address - Phone:949-586-3200
Mailing Address - Fax:949-900-2136
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:STE 200
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2753
Practice Address - Country:US
Practice Address - Phone:949-586-3200
Practice Address - Fax:949-900-2136
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT08251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9105000224OtherCERTIFIED HAND THERAPIST