Provider Demographics
NPI:1417148222
Name:MANGAS, AMANDA RASHELLA (MOT, OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RASHELLA
Last Name:MANGAS
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:RASHELLA
Other - Last Name:AGACINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMANDA MANGAS
Mailing Address - Street 1:49664 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2526
Mailing Address - Country:US
Mailing Address - Phone:586-435-6942
Mailing Address - Fax:
Practice Address - Street 1:49664 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2526
Practice Address - Country:US
Practice Address - Phone:586-435-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist