Tara Manzano, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056006377 Issued in IL

Practice address

101 S Graham Ave
Suite 3
Carbondale, IL 62901-3043

Phone

(618) 305-4696

NPI assigned

Nov 27, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myofascial Release of Southern IllinoisGroup PAC ID 4284867151, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Myofascial Release of Southern Illinois

  • Rehabilitation Clinic/Center
  • Carbondale, IL
  • NPI 1851722946
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1164853255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2031",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629022031",
            "telephone_number": "618-305-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S GRAHAM AVE",
            "address_2": "SUITE 3",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013043",
            "telephone_number": "618-305-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZANO",
        "first_name": "TARA",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-27",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056006377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adedoyin Idayat Malik, DDS
• Is-Haq Malik, MD
• Sara B Malone, MD
• Desma Elizabeth Manigault-McElveen
• Eric Manzano, P.T.
• Allen Wayne Mardis, ATC
• Abbey Margolis, MSW, LSW
• Marion Eye Centers LTD
• Marion Eye Centers LTD.
• Mark L Westphal

• Occupational Therapist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.