Provider Demographics
NPI:1487103974
Name:DYBEVIK, HALLIE (OTR)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:DYBEVIK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:
Other - Last Name:ZUBELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4023
Practice Address - Country:US
Practice Address - Phone:608-890-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5928 - 26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist