Individual
CARLA MANGINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
138 STONERIDGE DR N STE 4, RUCKERSVILLE, VA 22968-3063
(434) 985-2288
(434) 985-6909
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(631) 580-5200
(631) 580-5200
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT.0000956
INSURANCE
CO
05
—
OT.0000956
—
CO
Enumeration date
08/21/2017
Last updated
01/03/2020
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