MEDICARE: MS. KRISTY T MONTERO

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	224Z00000X	Occupational Therapy Assistant	12112	FL

General Provider Information

NPI Number	:	1508130055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTY T MONTERO

Provider Business Mailing Address
First Line	:	13 RADIUS PL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5015
Country	:	US
Telephone Number	:	386-627-9559
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 RADIUS PL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5015
Country	:	US
Telephone Number	:	386-627-9559
Fax Number	:

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

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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