MEDICARE: BERNICE N. MONTOYA O.T.

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	OT 5089	CA

General Provider Information

NPI Number	:	1962451906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNICE N. MONTOYA O.T.

Provider Business Mailing Address
First Line	:	5962 LA PLACE CT
Second Line	:	STE 170
City	:	CARLSBAD
State	:	CA
Zip	:	92008-8807
Country	:	US
Telephone Number	:	800-929-4776
Fax Number	:	760-931-8370

Provider Business Practice Location Address
First Line	:	12215 TELEGRAPH RD
Second Line	:	#110
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	562-777-1333
Fax Number	:	562-777-1347

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/08/2007

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