Provider Demographics
NPI:1265741326
Name:STAPLES, DIANE (COTA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N CHURCH
Mailing Address - Street 2:
Mailing Address - City:SCHOENCHEN
Mailing Address - State:KS
Mailing Address - Zip Code:67667
Mailing Address - Country:US
Mailing Address - Phone:785-639-5540
Mailing Address - Fax:
Practice Address - Street 1:208 N CHURCH
Practice Address - Street 2:
Practice Address - City:SCHOENCHEN
Practice Address - State:KS
Practice Address - Zip Code:67667
Practice Address - Country:US
Practice Address - Phone:785-639-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00068224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant