Individual
MRS. BLANCA IVETTE MANRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4201 STONEGATE BLVD, FORT WORTH, TX 76109-9503
(817) 924-5440
Mailing address
3625 CLUBGATE DR, FORT WORTH, TX 76137-2928
(915) 373-8721
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214069
TX
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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