Healthcare Provider Details

I. General information

NPI: 1699920074
Provider Name (Legal Business Name): DANIELLE M WESTENDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE M DETERS

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MEDICAL PARK DR SUITE 100
EFFINGHAM IL
62401-2191
US

IV. Provider business mailing address

901 MEDICAL PARK DR SUITE 100
EFFINGHAM IL
62401-2191
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-3003
  • Fax: 217-347-3005
Mailing address:
  • Phone: 217-347-3003
  • Fax: 217-347-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056008540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: