Provider Demographics
NPI:1972029957
Name:MANGINE, CARLA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MANGINE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5200
Practice Address - Street 1:138 STONERIDGE DR N STE 4
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3063
Practice Address - Country:US
Practice Address - Phone:434-985-2288
Practice Address - Fax:434-985-6909
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOT.0000956OtherINSURANCE
COOT.0000956Medicaid