Provider Demographics
NPI:1427331867
Name:NOWAK, DIANE SOPHIA (COTA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SOPHIA
Last Name:NOWAK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SNYDERWOODS CT
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2562
Mailing Address - Country:US
Mailing Address - Phone:716-837-2061
Mailing Address - Fax:
Practice Address - Street 1:38 SNYDERWOODS CT
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-2562
Practice Address - Country:US
Practice Address - Phone:716-837-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002990224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant