MEDICARE: AMY MANNINA OTR

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	225X00000X	Occupational Therapist	4427	CA

General Provider Information

NPI Number	:	1548944432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MANNINA OTR

Provider Business Mailing Address
First Line	:	4460 LAHAINA WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1958
Country	:	US
Telephone Number	:	408-836-6042
Fax Number	:

Provider Business Practice Location Address
First Line	:	4460 LAHAINA WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1958
Country	:	US
Telephone Number	:	408-836-6042
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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