Provider Demographics
NPI:1306181391
Name:MANABAT, GRACE HENSON (OTR/L)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:HENSON
Last Name:MANABAT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 131ST PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7104
Mailing Address - Country:US
Mailing Address - Phone:425-773-4445
Mailing Address - Fax:
Practice Address - Street 1:2522 131ST PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7104
Practice Address - Country:US
Practice Address - Phone:425-773-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4429314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility