Individual
MRS. DIANE JEAN MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
15840 LONG LAKE ROAD, DETROIT LAKES, MN 56501
(218) 847-5071
Mailing address
P.O. BOX 1382, DETROIT LAKES, MN 56502
(218) 234-1302
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
100296
MN
Other
Enumeration date
12/03/2008
Last updated
12/03/2008
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