Individual
ERIC DYBALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3538 NORTHRIDGE CT, APPLETON, WI 54914-6738
(920) 220-0844
Mailing address
3538 NORTHRIDGE CT, APPLETON, WI 54914-6738
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
5068-27
WI
224Z00000X
Occupational Therapy Assistant
Primary
OTA22019
NM
Other
Enumeration date
06/30/2014
Last updated
01/25/2023
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