MEDICARE: NANCY MANGINI 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	172V00000X	Community Health Worker	OT.000472	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT.000472	OTHER	OH	OHIO OCCUPATIONAL THERAPY

General Provider Information

NPI Number	:	1952574766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MANGINI OTR/L

Provider Business Mailing Address
First Line	:	1178 ELMWOOD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3257
Country	:	US
Telephone Number	:	614-395-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1178 ELMWOOD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3257
Country	:	US
Telephone Number	:	614-395-1448
Fax Number	:

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

Provider Enumeration Date	:	04/12/2008
Last Update Date	:	04/12/2008

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