Healthcare Provider Details

I. General information

NPI: 1205883055
Provider Name (Legal Business Name): PHYLLIS M DILUIGI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22423 US HIGHWAY 72 SUITE B
ATHENS AL
35613-2662
US

IV. Provider business mailing address

1908 FLINT RD SE
DECATUR AL
35601-6031
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-1221
  • Fax: 256-232-1231
Mailing address:
  • Phone: 256-340-9708
  • Fax: 256-340-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0517
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: