Provider Demographics
NPI:1902157753
Name:SEBELA, MARIELLE V (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:MARIELLE
Middle Name:V
Last Name:SEBELA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 OAKWOOD DR
Mailing Address - Street 2:UNIT 4C
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5800 OAKWOOD DR
Practice Address - Street 2:UNIT 4C
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2973
Practice Address - Country:US
Practice Address - Phone:630-709-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.002948224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant