Provider Demographics
NPI:1750589743
Name:DITMER, BARBARA JO (COTA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JO
Last Name:DITMER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ARCADE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2486
Mailing Address - Country:US
Mailing Address - Phone:574-296-9100
Mailing Address - Fax:
Practice Address - Street 1:500 ARCADE AVE STE 300
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2486
Practice Address - Country:US
Practice Address - Phone:574-296-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000479A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation