Provider Demographics
NPI:1154827574
Name:MONTZ, KAROL DALE
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:DALE
Last Name:MONTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4438
Mailing Address - Country:US
Mailing Address - Phone:410-567-3462
Mailing Address - Fax:
Practice Address - Street 1:606 EDMONDSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3352
Practice Address - Country:US
Practice Address - Phone:410-567-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR02014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist