Provider Demographics
NPI:1275195406
Name:MANUSH, JAYNE BANKS (MS, OTR/L, ATP)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:BANKS
Last Name:MANUSH
Suffix:
Gender:F
Credentials:MS, OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LITTLE RAVEN ST APT 343
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-7170
Mailing Address - Country:US
Mailing Address - Phone:251-533-2701
Mailing Address - Fax:
Practice Address - Street 1:7265 CATAMOUNT STREET
Practice Address - Street 2:
Practice Address - City:GREEN MOUNTAIN FALLS
Practice Address - State:CO
Practice Address - Zip Code:80819
Practice Address - Country:US
Practice Address - Phone:719-331-1011
Practice Address - Fax:719-398-0794
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005985225X00000X
AL4403225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty