Provider Demographics
NPI:1083049977
Name:MCMANUS, MARK (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LEHMAN LN
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3449
Mailing Address - Country:US
Mailing Address - Phone:415-328-7536
Mailing Address - Fax:
Practice Address - Street 1:178 DENSLOWE DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-2035
Practice Address - Country:US
Practice Address - Phone:415-548-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9994171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor