Healthcare Provider Details

I. General information

NPI: 1134046089
Provider Name (Legal Business Name): ESTELA WEBER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E STATE ST
BURLINGTON WI
53105-1639
US

IV. Provider business mailing address

5300 N MASON AVE
CHICAGO IL
60630-1125
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-9531
  • Fax:
Mailing address:
  • Phone: 773-780-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9232-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: