Provider Demographics
NPI:1528652021
Name:MANGLOS, STEPHANIE (COTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MANGLOS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NE CASADY LN APT 105
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6935
Mailing Address - Country:US
Mailing Address - Phone:816-519-4527
Mailing Address - Fax:
Practice Address - Street 1:9225 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8592
Practice Address - Country:US
Practice Address - Phone:515-978-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist