Healthcare Provider Details

I. General information

NPI: 1922870120
Provider Name (Legal Business Name): CHRISTINA MONTALBANO MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 E STATE ROAD 64
BRADENTON FL
34208-9041
US

IV. Provider business mailing address

3823 E STATE ROAD 64
BRADENTON FL
34208-9041
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT24705
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: