MEDICARE: MR. ELVIS MANZANILLO

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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1366709370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELVIS MANZANILLO

Provider Business Mailing Address
First Line	:	2005 PALMER AVE # 231
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-2437
Country	:	US
Telephone Number	:	347-259-9156
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 PALMER AVE # 231
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-2437
Country	:	US
Telephone Number	:	347-259-9156
Fax Number	:

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

Provider Enumeration Date	:	04/15/2012
Last Update Date	:	04/15/2012

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Directions to “ MR. ELVIS MANZANILLO ” Practice Location

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