Provider Demographics
NPI:1285707448
Name:PICKEL, DIANE P (OTRL)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:PICKEL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13604 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-5110
Mailing Address - Country:US
Mailing Address - Phone:913-669-3850
Mailing Address - Fax:913-747-6101
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-747-6100
Practice Address - Fax:913-747-6101
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700259225X00000X
MO002774225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN94C348Medicare ID - Type Unspecified