Provider Demographics
NPI:1013393123
Name:MANN, MICHELLE ELLEN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELLEN
Last Name:MANN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 WESTPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8420
Mailing Address - Country:US
Mailing Address - Phone:252-342-1443
Mailing Address - Fax:
Practice Address - Street 1:1508 WESTPOINTE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8420
Practice Address - Country:US
Practice Address - Phone:252-342-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9093224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant