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MR. MARTIN JOSEPH DIEDRICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
COTA

Contact information

Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(180) 036-0838
(260) 421-1821
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(180) 036-0838
(260) 421-1821

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001469A
IN

Other

Enumeration date
11/29/2010
Last updated
11/29/2010
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