Diane Simone Stukes, COTA/L

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-23-252400 Issued in GA

Practice address

3727 Executive Center Dr
Augusta, GA 30907-2398

Phone

(706) 842-5330

Fax

(706) 842-5340

NPI assigned

Jan 18, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Diane Simone Rose Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1831804525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2567",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309032567",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3727 EXECUTIVE CENTER DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309072398",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUKES",
        "first_name": "DIANE",
        "middle_name": "SIMONE",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-18",
        "last_updated": "2023-01-18",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-23-252400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "ROSE",
            "middle_name": "SIMONE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William B Strong, MD
• Chelsey Strowbridge
• Jacqueline Strowd, PHD
• Charles A Studley, PA
• Stacie Brooke Studstill, DNP
• Lauren Stull
• Doris Sturcken, NP-C
• Dallas Sturdevant, DO
• Mikenzie Lynn Sturdevant, DO
• Lashon Sturgis, M.D.

• Behavior Technician in Augusta, GA
• Providers in Augusta, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.