Healthcare Provider Details

I. General information

NPI: 1972667996
Provider Name (Legal Business Name): MICHELLE MONTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

112 PLEASANT HILL RD
SEBASTOPOL CA
95472-4015
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: