Provider Demographics
NPI:1780339697
Name:MANGANELLO, CURTIS (OTR)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:MANGANELLO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ARLENE ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3832
Mailing Address - Country:US
Mailing Address - Phone:860-796-9311
Mailing Address - Fax:847-386-5180
Practice Address - Street 1:1000 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5571
Practice Address - Country:US
Practice Address - Phone:860-851-9328
Practice Address - Fax:847-730-2490
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist