Provider Demographics
NPI:1710193164
Name:MANNING, MARYANNE CONWAY (COTAL)
Entity Type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:CONWAY
Last Name:MANNING
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 GREENSPIRE CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6723
Mailing Address - Country:US
Mailing Address - Phone:724-272-0546
Mailing Address - Fax:
Practice Address - Street 1:527 GREENSPIRE CT
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6723
Practice Address - Country:US
Practice Address - Phone:724-272-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA224Z00000X224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant