Provider Demographics
NPI:1568676187
Name:MANTZ, JENNIFER (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MANTZ
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LEE RAE CT
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22657-3872
Mailing Address - Country:US
Mailing Address - Phone:540-247-4375
Mailing Address - Fax:
Practice Address - Street 1:3150 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4208
Practice Address - Country:US
Practice Address - Phone:405-420-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979907Medicaid