Healthcare Provider Details

I. General information

NPI: 1518414598
Provider Name (Legal Business Name): JANET C. SEBELA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 THAYER CT STE 500C
AURORA IL
60504-6183
US

IV. Provider business mailing address

PO BOX 441146
KENNESAW GA
30160-9522
US

V. Phone/Fax

Practice location:
  • Phone: 630-870-4735
  • Fax: 630-984-2177
Mailing address:
  • Phone: 770-917-1395
  • Fax: 770-423-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.005399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: