| Mr James Michael Dibauda, OTRL | |
|
202 Village Dr, Lagrange, GA 30240-8831 | |
| (706) 884-6403 | |
| (706) 884-6403 |
| Full Name | Mr James Michael Dibauda |
|---|---|
| Gender | Male |
| Speciality | Occupational Therapist |
| Location | 202 Village Dr, Lagrange, Georgia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356335293 | NPI | - | NPPES |
| 3963141 | Other | GA | AETNA PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | OT004061 (Georgia) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Mr James Michael Dibauda, OTRL 202 Village Dr, Lagrange, GA 30240-8831 Ph: (706) 884-6403 | Mr James Michael Dibauda, OTRL 202 Village Dr, Lagrange, GA 30240-8831 Ph: (706) 884-6403 |
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