Provider Demographics
NPI:1417976093
Name:MONTAGUE, MELINDA MORGAN (MOT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MORGAN
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2430
Mailing Address - Country:US
Mailing Address - Phone:816-756-0780
Mailing Address - Fax:
Practice Address - Street 1:3101 MAIN STREET
Practice Address - Street 2:( CHILDREN'S TLC EASTER SEALS)
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-756-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02349225X00000X
MO2006013592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist