Provider Demographics
NPI:1598894461
Name:MANN, MARTHA (OTR)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 W WESTLAKES CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-5220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 N CARRIAGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4510
Practice Address - Country:US
Practice Address - Phone:316-684-8735
Practice Address - Fax:316-684-2128
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700740225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist