Provider Demographics
NPI:1922124411
Name:DIBERT, JILL ALAINE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ALAINE
Last Name:DIBERT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BEL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1501
Mailing Address - Country:US
Mailing Address - Phone:724-327-7445
Mailing Address - Fax:
Practice Address - Street 1:2904 SEMINARY DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3700
Practice Address - Country:US
Practice Address - Phone:724-832-8272
Practice Address - Fax:724-837-8278
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007036L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018896400004Medicaid