Provider Demographics
NPI:1558607333
Name:MANNINO, TAMMY COLLETTE (COTA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:COLLETTE
Last Name:MANNINO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MONTREAT RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3137
Mailing Address - Country:US
Mailing Address - Phone:352-638-6719
Mailing Address - Fax:
Practice Address - Street 1:75 FISHER LOOP
Practice Address - Street 2:
Practice Address - City:MAGGIE VALLEY
Practice Address - State:NC
Practice Address - Zip Code:28751-5531
Practice Address - Country:US
Practice Address - Phone:828-566-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-22
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001991224Z00000X
NC2414224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant