Active NPI
Mark A Mannetti, PT
- Occupational Therapist
- Winston Salem, NC
National Provider Identifier
1528394087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 12384
- Practice address
- 1903 S Hawthorne Rd
Winston Salem, NC 27103-3916 - Phone
- (336) 996-7001
- Fax
- (336) 996-0832
- NPI assigned
- Oct 19, 2009
- Last updated
- Oct 21, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 12384 | NC | Primary |
Addresses
Primary practice location
1903 S Hawthorne Rd
Winston Salem, NC 27103-3916
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 996-7001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12384 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256083200000",
"number": "1528394087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751803",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751803",
"telephone_number": "336-996-7001",
"fax_number": "336-996-0832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1903 S HAWTHORNE RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271033916",
"telephone_number": "336-996-7001",
"fax_number": "336-996-0832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNETTI",
"first_name": "MARK",
"middle_name": "A",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-19",
"last_updated": "2009-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "12384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.