Provider Demographics
NPI:1013057124
Name:MANNI, DEBORAH F (OT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:F
Last Name:MANNI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:F
Other - Last Name:TOLLEFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 KELLER AVE N
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1036
Mailing Address - Country:US
Mailing Address - Phone:715-268-1001
Mailing Address - Fax:715-268-1002
Practice Address - Street 1:220 KELLER AVE N
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1036
Practice Address - Country:US
Practice Address - Phone:715-268-1001
Practice Address - Fax:715-268-1002
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4127OtherSTATE LICENSE