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General NPI Number Information
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NPI Number | 1144613175
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Entity Type | Individual
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Provider Name | VANESSA ALEXANDRA MONTELONGO OTR
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Gender | Female
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 5720 LBJ FWY STE 190
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City | DALLAS
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State | TX
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Zip | 75240-6366
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Country | US
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Telephone | 972-808-2329
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 N HALL ST
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City | DALLAS
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State | TX
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Zip | 75219-5416
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Country | US
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Telephone | 214-559-5456
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Fax | 214-559-4754
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 116805
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License Number State | TX
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