Provider Demographics
NPI:1801011408
Name:DIBLE, RONDA MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:MARIE
Last Name:DIBLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:MARIE
Other - Last Name:FREEMANTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:105 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3316
Mailing Address - Country:US
Mailing Address - Phone:630-627-3925
Mailing Address - Fax:
Practice Address - Street 1:105 W MADISON ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3316
Practice Address - Country:US
Practice Address - Phone:630-627-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRD16610203POtherEI CREDENTIAL