Provider Demographics
NPI:1275832404
Name:WISSEL, BECKI RACHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BECKI
Middle Name:RACHELLE
Last Name:WISSEL
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 1:625 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:IL
Mailing Address - Zip Code:61427-5109
Mailing Address - Country:US
Mailing Address - Phone:309-785-5079
Mailing Address - Fax:309-785-5079
Practice Address - Street 1:625 E MONROE ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:IL
Practice Address - Zip Code:61427-5109
Practice Address - Country:US
Practice Address - Phone:309-785-5079
Practice Address - Fax:309-785-5079
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist