Provider Demographics
NPI:1083598551
Name:COLEMAN, DIANNA PEARL (COTA)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:PEARL
Last Name:COLEMAN
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 1:1110 POOR FARM RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-4646
Mailing Address - Country:US
Mailing Address - Phone:276-254-0636
Mailing Address - Fax:
Practice Address - Street 1:1000 LITTON LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6399
Practice Address - Country:US
Practice Address - Phone:540-552-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001374224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant