MEDICARE: JOELLE DIMMIG OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	021849-1	NY
2	225X00000X	Occupational Therapist	021849	NY

General Provider Information

NPI Number	:	1225542210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLE DIMMIG OTR/L

Provider Business Mailing Address
First Line	:	2900 DELAWARE AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-2309
Country	:	US
Telephone Number	:	716-871-9883
Fax Number	:	716-871-9887

Provider Business Practice Location Address
First Line	:	17 LIMESTONE DR STE 5
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8601
Country	:	US
Telephone Number	:	716-871-9883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	03/11/2024

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