Provider Demographics
NPI:1487101010
Name:GAFFIN, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GAFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HIGHLAND AVE.
Mailing Address - Street 2:RIVERSIDE EARLY INTERVENTION
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:781-449-1884
Mailing Address - Fax:
Practice Address - Street 1:255 HIGHLAND AVE
Practice Address - Street 2:RIVERSIDE EARLY INTERVENTION
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3023
Practice Address - Country:US
Practice Address - Phone:781-449-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8558225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics