Healthcare Provider Details

I. General information

NPI: 1184751901
Provider Name (Legal Business Name): MANUEL HERRERA OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26575 W COMMERCE DR UNIT 506
VOLO IL
60073-9659
US

IV. Provider business mailing address

26575 W COMMERCE DR UNIT 506
VOLO IL
60073-9659
US

V. Phone/Fax

Practice location:
  • Phone: 847-740-6229
  • Fax: 847-740-6447
Mailing address:
  • Phone: 847-740-6229
  • Fax: 847-740-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.005548
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number056005548
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: