Provider Demographics
NPI:1982929204
Name:KOLAK, DEBRA HELEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:HELEN
Last Name:KOLAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:HELEN
Other - Last Name:CHIODO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1613 KIRBY CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9206
Mailing Address - Country:US
Mailing Address - Phone:630-983-7501
Mailing Address - Fax:
Practice Address - Street 1:1804 CENTRE POINT CIR STE 102
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4849
Practice Address - Country:US
Practice Address - Phone:630-955-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-001825225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist