Provider Demographics
NPI:1255590386
Name:MANIRE, KAREN D (OT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:D
Last Name:MANIRE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3406
Mailing Address - Country:US
Mailing Address - Phone:267-864-7803
Mailing Address - Fax:
Practice Address - Street 1:7210 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3406
Practice Address - Country:US
Practice Address - Phone:267-864-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004002174400000X
VA0119000688174400000X
NC4494174400000X
PAOC002324L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist