Individual
MR. JAMES MICHAEL DIBAUDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
202 VILLAGE DR, LAGRANGE, GA 30240-8831
(706) 884-6403
(706) 884-6403
Mailing address
202 VILLAGE DR, LAGRANGE, GA 30240-8831
(706) 884-6403
(706) 884-6403
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004061
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3963141
AETNA PROVIDER NUMBER
GA
Enumeration date
09/07/2005
Last updated
07/09/2007
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