Individual
DIANE MILLER SUPAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
457 N MAIN ST, LA GRANGE, TX 78945-1937
(979) 968-5865
Mailing address
481 FM 2503, FAYETTEVILLE, TX 78940-5101
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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