Provider Demographics
NPI:1295106144
Name:MARRERO, MANNY (MOT, OTR/L, FCE)
Entity type:Individual
Prefix:
First Name:MANNY
Middle Name:
Last Name:MARRERO
Suffix:
Gender:M
Credentials:MOT, OTR/L, FCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NORTH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3825
Mailing Address - Country:US
Mailing Address - Phone:508-771-6685
Mailing Address - Fax:508-771-6687
Practice Address - Street 1:130 NORTH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3825
Practice Address - Country:US
Practice Address - Phone:508-771-6685
Practice Address - Fax:508-771-6687
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11738225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation