Provider Demographics
NPI:1962725820
Name:KNOLL, DIANE MARIE (OTR)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:KNOLL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 S NANCY ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6038
Mailing Address - Country:US
Mailing Address - Phone:812-219-0659
Mailing Address - Fax:
Practice Address - Street 1:11550 N MERIDIAN ST STE 312
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4562
Practice Address - Country:US
Practice Address - Phone:317-815-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004466A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist