Provider Demographics
NPI:1962916635
Name:SPECHT, DIANE CAROL (OTR)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:SPECHT
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 1:112 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2216
Mailing Address - Country:US
Mailing Address - Phone:201-259-1658
Mailing Address - Fax:
Practice Address - Street 1:1373 BROAD ST STE 302
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4200
Practice Address - Country:US
Practice Address - Phone:973-773-4263
Practice Address - Fax:973-773-4336
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00173400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist