1811196371 NPI number — DIANE S DOUGLAS OTR/L

Table of content: DIANE S DOUGLAS OTR/L (NPI 1811196371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811196371 NPI number — DIANE S DOUGLAS OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGLAS
Provider First Name:
DIANE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811196371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
538 DYE LEAF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRVIEW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28730-9652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-628-4644
Provider Business Mailing Address Fax Number:
828-628-4644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28711-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-338-9025
Provider Business Practice Location Address Fax Number:
888-739-8184
Provider Enumeration Date:
07/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1435 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6748 . This is a "BCBS PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com