Provider Demographics
NPI:1093044109
Name:MANO, STEPHANIE EMIKO (OTR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EMIKO
Last Name:MANO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 KIMBALL DR STE D403
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5141
Mailing Address - Country:US
Mailing Address - Phone:253-851-3874
Mailing Address - Fax:
Practice Address - Street 1:6659 KIMBALL DR STE D403
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5141
Practice Address - Country:US
Practice Address - Phone:253-851-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist