Healthcare Provider Details

I. General information

NPI: 1801277090
Provider Name (Legal Business Name): LAURIE GUNTER MANTZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 NORWOOD AVE
CRANSTON RI
02905-2711
US

IV. Provider business mailing address

299 NORWOOD AVE
CRANSTON RI
02905-2711
US

V. Phone/Fax

Practice location:
  • Phone: 603-264-1224
  • Fax:
Mailing address:
  • Phone: 603-264-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01457
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT01457
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: