Individual
SAMANTHA LYNNE MANGRAVITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
74 HASTINGS AVE, NUTLEY, NJ 07110-2578
(862) 262-3394
Mailing address
74 HASTINGS AVE, NUTLEY, NJ 07110-2578
(862) 262-3394
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00841400
NJ
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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