Provider Demographics
NPI:1174607469
Name:BROCATO, DIANE LYNN (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYNN
Last Name:BROCATO
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19810 OAK GREEN CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1273
Mailing Address - Country:US
Mailing Address - Phone:281-812-4170
Mailing Address - Fax:281-459-9136
Practice Address - Street 1:5810 E SAM HOUSTON PKWY N STE K
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2528
Practice Address - Country:US
Practice Address - Phone:281-459-9134
Practice Address - Fax:281-459-9136
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456810Medicare ID - Type UnspecifiedMEDICARE