Provider Demographics
NPI:1326400466
Name:MONTERO MALDONADO, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:MONTERO MALDONADO
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 1:319 S CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NOEL
Mailing Address - State:MO
Mailing Address - Zip Code:64854-9133
Mailing Address - Country:US
Mailing Address - Phone:417-669-5380
Mailing Address - Fax:
Practice Address - Street 1:319 S CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:NOEL
Practice Address - State:MO
Practice Address - Zip Code:64854-9133
Practice Address - Country:US
Practice Address - Phone:417-669-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1082224ZR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility