Provider Demographics
NPI:1477905339
Name:THAPA-PANTH, MANJILA (OT)
Entity Type:Individual
Prefix:
First Name:MANJILA
Middle Name:
Last Name:THAPA-PANTH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 STRAWBERRY HILL AVE APT 1126
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2743
Mailing Address - Country:US
Mailing Address - Phone:203-276-0469
Mailing Address - Fax:
Practice Address - Street 1:91 STRAWBERRY HILL AVE APT 1126
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2743
Practice Address - Country:US
Practice Address - Phone:203-276-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003342OtherSTATE LICENSE