Individual
KISHA MANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
68 SUMMER AVE, NEWARK, NJ 07104-2512
(862) 216-4030
Mailing address
68 SUMMER AVE, NEWARK, NJ 07104-2512
(862) 216-4030
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008107-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7744850
—
NY
Enumeration date
07/02/2014
Last updated
07/02/2014
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