MEDICARE: MARYORIE MONTALVO

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	235Z00000X	Speech-Language Pathologist	4979	OK

General Provider Information

NPI Number	:	1144710062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYORIE MONTALVO

Provider Business Mailing Address
First Line	:	4334 NW EXPRESSWAY STE 187
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1515
Country	:	US
Telephone Number	:	405-355-3239
Fax Number	:	405-421-9652

Provider Business Practice Location Address
First Line	:	2401 NW 23RD ST STE 2D
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2420
Country	:	US
Telephone Number	:	405-355-3239
Fax Number	:	405-421-9652

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

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	05/16/2018

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Directions to “ MARYORIE MONTALVO ” Practice Location

Language	Start Address	Practice Location

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