| NPI | 1063657120 |
|---|---|
| Former Name | DIANE JEAN BERG MCCORMACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: MN 100296) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2008-12-03 |