MEDICARE: MISS ERIN LEIGH MONTANO OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	8800	MA

General Provider Information

NPI Number	:	1104981190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERIN LEIGH MONTANO OT

Provider Business Mailing Address
First Line	:	54 SPOFFORD RD
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01607-1634
Country	:	US
Telephone Number	:	508-753-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 SPOFFORD RD
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01607-1634
Country	:	US
Telephone Number	:	508-753-5138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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