Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 01788 | RI |
NPI | 1740886142 |
---|---|
Provider Name | Diane M Mancini |
First Address | Coventry, RI 02816 |
Second Address | Coventry, RI 02816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2020 |
Last Update Date | 10/12/2020 |