Provider Demographics
NPI:1205667300
Name:DIMAGGIO, LUCINDA CHARLOTTE BISHOP (BIS)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:CHARLOTTE BISHOP
Last Name:DIMAGGIO
Suffix:
Gender:F
Credentials:BIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1155
Mailing Address - Street 2:
Mailing Address - City:OSBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83849-1155
Mailing Address - Country:US
Mailing Address - Phone:208-964-3073
Mailing Address - Fax:
Practice Address - Street 1:1257 E MULLAN AVE
Practice Address - Street 2:
Practice Address - City:OSBURN
Practice Address - State:ID
Practice Address - Zip Code:83849-0820
Practice Address - Country:US
Practice Address - Phone:208-964-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist