Provider Demographics
NPI:1598065179
Name:DILLABOUGH, DIANE MARIE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:MARIE
Last Name:DILLABOUGH
Suffix:
Gender:F
Credentials:COTA
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Mailing Address - Street 1:BOX 70 MIDDLE SETTLEMENT RD.
Mailing Address - Street 2:ONEIDA HERKIMER MADISON BOCES
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0070
Mailing Address - Country:US
Mailing Address - Phone:315-793-8525
Mailing Address - Fax:315-223-4748
Practice Address - Street 1:5176 ST ROUTE 233
Practice Address - Street 2:WESTMORELAND ELEMETARY SCHOOL
Practice Address - City:WESTMORELAND
Practice Address - State:NY
Practice Address - Zip Code:13490
Practice Address - Country:US
Practice Address - Phone:315-793-8525
Practice Address - Fax:315-223-4748
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003399-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant