Georgiann Lynn Dieteman, OTRL
Individual provider Active NPI Occupational Therapist · Elma, NY
NPI 1487794483 · NPPES record last updated Oct 14, 2009
Key facts
- NPI
- 1487794483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 0134411 (NY)
- Practice address
- 960 West Maple Court
Elma, NY 14059 - Phone
- (716) 805-1555
- Fax
- (716) 805-1444
- NPI assigned
- Feb 7, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Las Geriatric Care Services, Inc.
Practice addresses (Care Compare)
108 Buttercup Dr
Cranberry Township, PA 16066-6314
Phone (724) 900-4633
1323 Freedom Rd
Cranberry Township, PA 16066-5001
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210929002197 | PA | Practitioner - Occupational Therapist in Private Practice | 2466496948 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0134411 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suburban Adult Services-Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0134411 | NY | Yes |
Addresses
Primary practice location
960 West Maple Court
Elma, NY 14059
Mailing address
345 Countryside LN
Apartment 5
Orchard Park, NY 14127-1339
Phone (716) 574-7183
Other providers in Elma, NY
- Jessica Nicole Dehlinger
- Katie Lynn Delprince
- Keith F Delprince
- Crystal Ann Densmore
- Kathryn Lynne Diebold
- Shannon Kathryn Earl
- Claire Elizabeth Edsell
- Mick Ellis
- Elma Village Optical
- Elma Volunteer Fire Co Inc
All providers in Elma, NY · Occupational Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.