Provider Demographics
NPI:1053537233
Name:MANNY OT & ASSOCIATES LLC
Entity type:Organization
Organization Name:MANNY OT & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:847-740-6229
Mailing Address - Street 1:26575 W COMMERCE DR
Mailing Address - Street 2:UNIT 506
Mailing Address - City:VOLO
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9659
Mailing Address - Country:US
Mailing Address - Phone:847-740-6229
Mailing Address - Fax:847-740-6447
Practice Address - Street 1:26575 W COMMERCE DR
Practice Address - Street 2:UNIT 506
Practice Address - City:VOLO
Practice Address - State:IL
Practice Address - Zip Code:60073-9659
Practice Address - Country:US
Practice Address - Phone:847-740-6229
Practice Address - Fax:847-740-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBLUE SHIELDOther04932587