Individual
MR. IAN MICHAEL MANGUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2720 CHARLES TOWN RD, MARTINSBURG, WV 25405-5626
(304) 263-0933
Mailing address
12614 MAHOGANY ST, CUMBERLAND, MD 21502-5181
(301) 338-2745
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
A02877
MD
224Z00000X
Occupational Therapy Assistant
Primary
C2351
WV
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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