MEDICARE: MONTI SUGGS MS, OTL

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	225XP0200X	Pediatric Occupational Therapist
2	225X00000X	Occupational Therapist	120006	TX

General Provider Information

NPI Number	:	1619512647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTI SUGGS MS, OTL

Provider Business Mailing Address
First Line	:	2916 CROW VALLEY TRL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-6314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 CROW VALLEY TRL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-6314
Country	:	US
Telephone Number	:	704-236-2119
Fax Number	:

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

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	10/17/2023

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