Provider Demographics
NPI:1699079244
Name:DIAZ, MONICA BLAKE (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:BLAKE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:BLAKE
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:2 HARRIMAN CT
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1334
Mailing Address - Country:US
Mailing Address - Phone:845-304-5789
Mailing Address - Fax:
Practice Address - Street 1:2 HARRIMAN CT
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1334
Practice Address - Country:US
Practice Address - Phone:845-304-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015295-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist