Healthcare Provider Details

I. General information

NPI: 1104374701
Provider Name (Legal Business Name): ALLAN MARINAS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 CHATHAM DR
HOFFMAN ESTATES IL
60192-4637
US

IV. Provider business mailing address

5887 CHATHAM DR
HOFFMAN ESTATES IL
60192-4637
US

V. Phone/Fax

Practice location:
  • Phone: 224-650-9286
  • Fax:
Mailing address:
  • Phone: 224-650-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056010238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: