Healthcare Provider Details

I. General information

NPI: 1336036490
Provider Name (Legal Business Name): EMILY DEBOER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 N WASHINGTON ST
JANESVILLE WI
53548-2907
US

IV. Provider business mailing address

724 PHILADELPHIA AVE
WESTMONT IL
60559-1263
US

V. Phone/Fax

Practice location:
  • Phone: 608-754-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: