Provider Demographics
NPI:1215435193
Name:FIREMAN, DIANE MARIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:FIREMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MENZEL LN
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1219
Mailing Address - Country:US
Mailing Address - Phone:732-972-3492
Mailing Address - Fax:732-972-3492
Practice Address - Street 1:10 GIANT MAPLE CT
Practice Address - Street 2:
Practice Address - City:PERRINEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08535-1303
Practice Address - Country:US
Practice Address - Phone:732-792-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00078900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist