Provider Demographics
NPI:1750488664
Name:MANTZ, TYLA ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TYLA
Middle Name:ANN
Last Name:MANTZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-1842
Mailing Address - Country:US
Mailing Address - Phone:580-242-4706
Mailing Address - Fax:
Practice Address - Street 1:107 W PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-1842
Practice Address - Country:US
Practice Address - Phone:580-242-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist