Provider Demographics
NPI:1992918205
Name:SUMTER, DIANE RENEE (OTRL)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:RENEE
Last Name:SUMTER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MOUNTAIN ASH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7005
Mailing Address - Country:US
Mailing Address - Phone:406-640-1608
Mailing Address - Fax:
Practice Address - Street 1:875 BRIDGER DR STE J
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2303
Practice Address - Country:US
Practice Address - Phone:406-585-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OT-LIC-1003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist