MEDICARE: SUSAN MONTAGUE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OC60647121	WA
2	225XH1200X	Hand Occupational Therapist	OT61535586	WA

General Provider Information

NPI Number	:	1073026472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MONTAGUE OTR/L

Provider Business Mailing Address
First Line	:	414 W BAKERVIEW RD STE 110
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8180
Country	:	US
Telephone Number	:	360-752-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 W BAKERVIEW RD STE 110
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8180
Country	:	US
Telephone Number	:	360-752-5551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	03/29/2024

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