Individual
DEREK MANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-8450
Mailing address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-8450
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5591-26
WI
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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