Provider Demographics
NPI:1053444109
Name:IACOBO, DINO B (OTRL)
Entity Type:Individual
Prefix:MR
First Name:DINO
Middle Name:B
Last Name:IACOBO
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WAVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3642
Mailing Address - Country:US
Mailing Address - Phone:401-438-3250
Mailing Address - Fax:401-438-4813
Practice Address - Street 1:1 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1503
Practice Address - Country:US
Practice Address - Phone:401-438-3250
Practice Address - Fax:401-438-4813
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT 00856225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist