Provider Demographics
NPI:1306131248
Name:LIENEMANN, DIANA HORTON (OTR)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:HORTON
Last Name:LIENEMANN
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:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1502
Mailing Address - Country:US
Mailing Address - Phone:970-668-5411
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR.
Practice Address - Street 2:SUITE 190
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-0785
Practice Address - Country:US
Practice Address - Phone:979-668-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist