MEDICARE: LEAH MANCINI OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	100047-4201	UT

General Provider Information

NPI Number	:	1215337811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH MANCINI OTR/L

Provider Business Mailing Address
First Line	:	1205 E 4725 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4917
Country	:	US
Telephone Number	:	801-262-2908
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 E 4725 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4917
Country	:	US
Telephone Number	:	801-262-2908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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