Individual
DIANE KHALSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2022 E MULBERRY DR, PHOENIX, AZ 85016-7218
(904) 738-9757
Mailing address
2022 E MULBERRY DR, PHOENIX, AZ 85016-7218
(904) 738-9757
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6141
AZ
Other
Enumeration date
10/11/2017
Last updated
01/22/2023
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