Healthcare Provider Details

I. General information

NPI: 1992139869
Provider Name (Legal Business Name): JANE MONTANARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N MIAMI ST
CHOUTEAU OK
74337-3765
US

IV. Provider business mailing address

1303 N MIAMI ST
CHOUTEAU OK
74337-3765
US

V. Phone/Fax

Practice location:
  • Phone: 918-289-0550
  • Fax:
Mailing address:
  • Phone: 918-289-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6064
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: