Provider Demographics
NPI:1386757318
Name:CHIN, MALINA (OT)
Entity type:Individual
Prefix:
First Name:MALINA
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MALINA
Other - Middle Name:S F
Other - Last Name:CHIN KUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:95 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3137
Mailing Address - Country:US
Mailing Address - Phone:847-281-9999
Mailing Address - Fax:847-281-9998
Practice Address - Street 1:326 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2819
Practice Address - Country:US
Practice Address - Phone:847-281-9003
Practice Address - Fax:847-281-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000655171100000X
IL056001332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171100000XOther Service ProvidersAcupuncturist