Provider Demographics
NPI:1316074933
Name:URQUHART, DIANE MARIE (NCTMB)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:URQUHART
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12960 BORGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1035
Mailing Address - Country:US
Mailing Address - Phone:248-227-1845
Mailing Address - Fax:
Practice Address - Street 1:16000 W 9 MILE RD
Practice Address - Street 2:SUITE 550
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4808
Practice Address - Country:US
Practice Address - Phone:248-559-6277
Practice Address - Fax:248-559-6278
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist