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General NPI Number Information
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NPI Number | 1235506064
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Entity Type | Individual
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Provider Name | ROSEMARIE MONTEHERMOSO
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Gender | Female
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 101 SUMMIT AVE SUITE 510
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City | FORT WORTH
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State | TX
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Zip | 76102-2618
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Country | US
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Telephone | 540-413-6316
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 SONGHUM DR
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City | FORT WORTH
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State | TX
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Zip | 76179
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Country | US
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Telephone | 540-413-6316
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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 | 112538
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License Number State | TX
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