Healthcare Provider Details

I. General information

NPI: 1407383995
Provider Name (Legal Business Name): LAURELLE MONTAGNE OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD
PASADENA CA
91107-6622
US

IV. Provider business mailing address

260 S AVENUE 57 APT F
LOS ANGELES CA
90042-5210
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax:
Mailing address:
  • Phone: 315-877-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: