Provider Demographics
NPI:1649702812
Name:MANITZ, DIANA MARIJA (OTR)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIJA
Last Name:MANITZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIJA
Other - Last Name:JANKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:14204 EISENBEISER DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9531
Mailing Address - Country:US
Mailing Address - Phone:586-556-1137
Mailing Address - Fax:
Practice Address - Street 1:3200 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9746
Practice Address - Country:US
Practice Address - Phone:586-556-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist