Provider Demographics
NPI:1588999205
Name:LEOPOLD, DIANE M (OTR/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:OTR/L
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4992 BRISTOL INDUSTRIAL WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1742
Mailing Address - Country:US
Mailing Address - Phone:770-904-6419
Mailing Address - Fax:770-904-6418
Practice Address - Street 1:4992 BRISTOL INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1742
Practice Address - Country:US
Practice Address - Phone:770-904-6419
Practice Address - Fax:770-904-6418
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics