Healthcare Provider Details

I. General information

NPI: 1871964858
Provider Name (Legal Business Name): ERICA DYBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-2923
US

IV. Provider business mailing address

9601 S HARBOUR POINTE DR
BLOOMINGTON IN
47401-8428
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-1037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002893A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: