Individual
DIANE GAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
644 SEAMANS NECK RD, SEAFORD, NY 11783-1130
(919) 800-8087
Mailing address
644 SEAMANS NECK RD, SEAFORD, NY 11783-1130
(919) 800-8087
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
004155
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004155
LICENSE #
NY
Enumeration date
10/18/2012
Last updated
10/18/2012
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