Provider Demographics
NPI:1528244738
Name:HARLOWE, DIANE (OT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HARLOWE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8054 WATTS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3811
Mailing Address - Country:US
Mailing Address - Phone:608-662-5062
Mailing Address - Fax:608-662-5061
Practice Address - Street 1:1265 JOHN Q HAMMONS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1941
Practice Address - Country:US
Practice Address - Phone:608-251-4156
Practice Address - Fax:608-257-3842
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1284OtherLICENSE