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General NPI Number Information
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NPI Number | 1750440079
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Entity Type | Organization
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Legal Business Name | SUMMIT HAND THERAPY, LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 1022 MOUNT WHITNEY DR
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City | SUMMERVILLE
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State | SC
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Zip | 29483-3318
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Country | US
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Telephone | 413-949-0986
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 MOUNT WHITNEY DR
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City | SUMMERVILLE
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State | SC
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Zip | 29483-3318
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Country | US
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Telephone | 413-949-0986
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTINA ELLEN MANNIELLO
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Credential | OT
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Telephone | 413-949-0986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 3313
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License Number State | MA
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