Individual
DEANNE BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
324 ROXBURY RD, ROCKFORD, IL 61107-5090
(815) 398-9491
(815) 381-7498
Mailing address
BOX 78534, MILWAUKEE, WI 53278-8534
(815) 398-9491
(815) 381-7498
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XH1200X
Hand Occupational Therapist
056-001827
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056001827
STATE LICENSE
IL
01
—
753210
MEDICARE GROUP
IL
Enumeration date
05/26/2006
Last updated
06/14/2019
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