Provider Demographics
NPI:1093106734
Name:DUBIN, DEENA A (MOT)
Entity Type:Individual
Prefix:MS
First Name:DEENA
Middle Name:A
Last Name:DUBIN
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 N PINE GROVE AVE
Mailing Address - Street 2:APT 1704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3346
Mailing Address - Country:US
Mailing Address - Phone:847-219-9673
Mailing Address - Fax:
Practice Address - Street 1:3705 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3540
Practice Address - Country:US
Practice Address - Phone:847-947-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist