Provider Demographics
NPI:1154461424
Name:WALLENBERG, DEBRA K (OT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:K
Last Name:WALLENBERG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W103 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2925
Mailing Address - Country:US
Mailing Address - Phone:630-890-8891
Mailing Address - Fax:630-690-8893
Practice Address - Street 1:26W103 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2925
Practice Address - Country:US
Practice Address - Phone:630-890-8891
Practice Address - Fax:630-690-8893
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics