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NPI Code Detail

MEDICARE: MS. DEENA A MABORANG MOT

MEDICARE: MS. DEENA A MABORANG MOT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist056010092IL

General Provider Information

NPI Number : 1093106734
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEENA A MABORANG MOT
Provider Business Mailing Address
First Line : 764 JUNE TER
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-6252
Country : US
Telephone Number : 847-219-9673
Fax Number :
Provider Business Practice Location Address
First Line : 14 FAWN RIDGE DR
Second Line :
City : OAKWOOD HILLS
State : IL
Zip : 60013-1069
Country : US
Telephone Number : 847-312-6421
Fax Number : 224-397-6248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2015
Last Update Date : 03/27/2025

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