Healthcare Provider Details

I. General information

NPI: 1114519261
Provider Name (Legal Business Name): STEFANI MANCHICK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 STARKEY BLVD
TRINITY FL
34655-2175
US

IV. Provider business mailing address

4436 W BAY VILLA AVE
TAMPA FL
33611-1122
US

V. Phone/Fax

Practice location:
  • Phone: 813-364-2391
  • Fax:
Mailing address:
  • Phone: 216-647-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT011185
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-318987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: