Provider Demographics
NPI:1174883904
Name:MONTANO, ANDREA JEANETTE (OT/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEANETTE
Last Name:MONTANO
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10309 DUNBAR ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5522
Mailing Address - Country:US
Mailing Address - Phone:505-459-7407
Mailing Address - Fax:
Practice Address - Street 1:10309 DUNBAR ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5522
Practice Address - Country:US
Practice Address - Phone:505-459-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist