MEDICARE: NURIS MONTERO MS,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	225X00000X	Occupational Therapist	OT11967	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C12867	OTHER	FL	MEDICARE R.R. GROUP

General Provider Information

NPI Number	:	1770505125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NURIS MONTERO MS,OTR/L

Provider Business Mailing Address
First Line	:	3470 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3548
Country	:	US
Telephone Number	:	352-527-5433
Fax Number	:	352-527-4199

Provider Business Practice Location Address
First Line	:	3470 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3548
Country	:	US
Telephone Number	:	352-527-5433
Fax Number	:	352-527-4199

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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