Provider Demographics
NPI:1609128685
Name:DIBBLE, LINDSEY RYAN (OT R/L)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:RYAN
Last Name:DIBBLE
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9727
Mailing Address - Country:US
Mailing Address - Phone:585-762-6442
Mailing Address - Fax:
Practice Address - Street 1:7920 SHORT ST
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9727
Practice Address - Country:US
Practice Address - Phone:585-762-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017644-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist