Provider Demographics
NPI:1548521057
Name:DUMBACHER, MICHELLE JEANNE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEANNE
Last Name:DUMBACHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:SHABBONA
Mailing Address - State:IL
Mailing Address - Zip Code:60550-9790
Mailing Address - Country:US
Mailing Address - Phone:815-824-2194
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4200
Practice Address - Country:US
Practice Address - Phone:512-263-4500
Practice Address - Fax:512-263-4500
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115808225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation