Individual
DIANA TINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, MS, OTR
Contact information
Practice address
3090 N ACADEMY BLVD, COLORADO SPRINGS, CO 80917-5368
(719) 574-8300
Mailing address
3090 N ACADEMY BLVD, COLORADO SPRINGS, CO 80917-5368
(719) 574-8300
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
31006512A
IN
225X00000X
Occupational Therapist
Primary
OT.0005421
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31006412
STATE LICENSE
IN
Enumeration date
01/10/2018
Last updated
06/25/2019
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