Provider Demographics
NPI:1780187260
Name:DEBRABANDER, KRISTA ANN (OT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:DEBRABANDER
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 1:15745 W CROBALLY WAY
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-7724
Mailing Address - Country:US
Mailing Address - Phone:815-955-0735
Mailing Address - Fax:815-717-7353
Practice Address - Street 1:15745 W CROBALLY WAY
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-7724
Practice Address - Country:US
Practice Address - Phone:815-955-0735
Practice Address - Fax:815-717-7353
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012437225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics