MEDICARE: SALLEY MONTREVIL OTR/L

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	2627	NM

General Provider Information

NPI Number	:	1568755122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLEY MONTREVIL OTR/L

Provider Business Mailing Address
First Line	:	7501 MONTGOMERY BLVD NE
Second Line	:	APT. 9304
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 W SR 436
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2921
Country	:	US
Telephone Number	:	800-226-9917
Fax Number	:

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

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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Directions to “ SALLEY MONTREVIL OTR/L” Practice Location

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