Provider Demographics
NPI:1063647519
Name:DELLER, ANMARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANMARIE
Middle Name:
Last Name:DELLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 CONSTANCE LN
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-9188
Mailing Address - Country:US
Mailing Address - Phone:815-790-8958
Mailing Address - Fax:
Practice Address - Street 1:2717 CONSTANCE LN
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-9188
Practice Address - Country:US
Practice Address - Phone:815-790-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.003272225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist