Provider Demographics
NPI:1659532216
Name:MANZANO, MICHELLE IGNACIO
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IGNACIO
Last Name:MANZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:IGNACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 4TH ST SW APT N406
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3004
Mailing Address - Country:US
Mailing Address - Phone:202-250-1823
Mailing Address - Fax:
Practice Address - Street 1:800 4TH ST SW APT N406
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3004
Practice Address - Country:US
Practice Address - Phone:202-250-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist