Provider Demographics
NPI:1043331325
Name:MANKES, CAROL KEREN
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:KEREN
Last Name:MANKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 SARAZEN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2266
Mailing Address - Country:US
Mailing Address - Phone:786-280-9300
Mailing Address - Fax:954-986-7498
Practice Address - Street 1:4938 SARAZEN DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2266
Practice Address - Country:US
Practice Address - Phone:786-280-9300
Practice Address - Fax:954-986-7498
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9974225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2721OtherBCBS