Most Relevant Information
Provider Data
| NPI Number: | 1003221888 |
| Provider Name: | ERIC DYBALA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 5068-27 |
Most Important Dates
| Enumeration Date: | 06/30/2014 |
| Last Updated: | 01/25/2023 |
Provider Practice Location
3538 NORTHRIDGE CT
APPLETON
WI
549146738
Practice Location Phone/Fax
| Phone: | 9202200844 |
| Fax: |
Provider Mailing Location
3538 NORTHRIDGE CT
APPLETON
WI
549146738
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |