Provider Demographics
NPI:1184934267
Name:MANILLI, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MANILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PENN ST
Mailing Address - Street 2:12
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2643
Mailing Address - Country:US
Mailing Address - Phone:321-768-6800
Mailing Address - Fax:321-768-6858
Practice Address - Street 1:1800 PENN ST
Practice Address - Street 2:12
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2643
Practice Address - Country:US
Practice Address - Phone:321-768-6800
Practice Address - Fax:321-768-6858
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14357225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist