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General NPI Number Information
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NPI Number | 1205616208
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Entity Type | Individual
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Provider Name | DOMINIC MONTALTO OT
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Gender | Male
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 712 N ELLINGTON PKWY STE 6
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City | LEWISBURG
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State | TN
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Zip | 37091-2454
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Country | US
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Telephone | 931-359-1913
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone |
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Fax |
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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 | 7809
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License Number State | TN
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