Healthcare Provider Details

I. General information

NPI: 1144352808
Provider Name (Legal Business Name): ELIZABETH ANN MONTELLA MOTT ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 DEER CREEK RD
PITTSFORD NY
14534-4146
US

IV. Provider business mailing address

48 DEER CREEK RD
PITTSFORD NY
14534-4146
US

V. Phone/Fax

Practice location:
  • Phone: 585-264-0518
  • Fax:
Mailing address:
  • Phone: 585-264-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: