Provider Demographics
NPI:1568648038
Name:MANASCO, LINDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MANASCO
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 1:117 GEMINI CIR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5874
Mailing Address - Country:US
Mailing Address - Phone:205-313-2800
Mailing Address - Fax:205-313-2801
Practice Address - Street 1:117 GEMINI CIR
Practice Address - Street 2:SUITE 407
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5874
Practice Address - Country:US
Practice Address - Phone:205-313-2800
Practice Address - Fax:205-313-2801
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL991187OtherAOTCB