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General NPI Number Information
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NPI Number | 1174499172
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Entity Type | Individual
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Provider Name | FIDESMARIE MANNING MS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1000 W CROSBY RD STE 136
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City | CARROLLTON
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State | TX
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Zip | 75006-6904
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Country | US
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Telephone | 972-237-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 315 BROOKLYN LN
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City | PONDER
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State | TX
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Zip | 76259-1005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 122668
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License Number State | TX
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