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General NPI Number Information
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NPI Number | 1710493598
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Entity Type | Individual
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Provider Name | ANTONIA MANN
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Gender | Female
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 6795 SKYVIEW PL NW
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City | BREMERTON
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State | WA
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Zip | 98311-8946
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Country | US
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Telephone | 877-712-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 7391 E MAPLE ST
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City | PORT ORCHARD
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State | WA
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Zip | 98366-8435
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 60802307
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License Number State | WA
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