Provider Demographics
NPI:1851784300
Name:MICHELLE NAVALANCE MARIANI
Entity Type:Organization
Organization Name:MICHELLE NAVALANCE MARIANI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NAVALANCE
Authorized Official - Last Name:MARIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-789-0408
Mailing Address - Street 1:500 TANNER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4730
Mailing Address - Country:US
Mailing Address - Phone:985-789-0408
Mailing Address - Fax:
Practice Address - Street 1:500 TANNER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4730
Practice Address - Country:US
Practice Address - Phone:985-789-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101821261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22Medicare PIN