MEDICARE: MIA REID MONTANYE 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	OT15256	FL

General Provider Information

NPI Number	:	1265978225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA REID MONTANYE OT

Provider Business Mailing Address
First Line	:	PO BOX 1975
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30162-1975
Country	:	US
Telephone Number	:	904-619-5831
Fax Number	:	866-225-4350

Provider Business Practice Location Address
First Line	:	10660 OLD SAINT AUGUSTINE RD STE PT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1076
Country	:	US
Telephone Number	:	904-619-5831
Fax Number	:	866-225-4350

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

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	04/11/2017

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