Provider Demographics
NPI:1356972723
Name:MANSPEAKER, TREVOR DAVID (OTD, OTR)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:DAVID
Last Name:MANSPEAKER
Suffix:
Gender:M
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-6617
Mailing Address - Country:US
Mailing Address - Phone:574-850-7332
Mailing Address - Fax:
Practice Address - Street 1:3630 HICKORY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8865
Practice Address - Country:US
Practice Address - Phone:574-252-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007043A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist