Individual
DIANNE ISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4030 INMAN PARK LANE, BUFORD, GA 30519
(678) 482-6100
(770) 932-5684
Mailing address
2108 WOODIRON DR, DULUTH, GA 30097-7498
(678) 482-6100
(770) 932-5684
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003740
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
896011253E
—
GA
Enumeration date
08/09/2007
Last updated
08/09/2007
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