Provider Demographics
NPI:1831355866
Name:EBEL, ERIN MARIE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:EBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5021
Mailing Address - Country:US
Mailing Address - Phone:708-309-9114
Mailing Address - Fax:
Practice Address - Street 1:742 BETHEL AVE
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-5021
Practice Address - Country:US
Practice Address - Phone:708-309-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist