Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT01457 | RI |
N | 225XG0600X | Occupational Therapist - Gerontology | OT01457 | RI |
NPI | 1801277090 |
---|---|
Provider Name | Laurie Gunter Mantz |
First Address | Cranston, RI 02905-2711 |
Second Address | Cranston, RI 02905-2711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 22/11/2019 |