Provider Demographics
NPI:1427537398
Name:MONTELLO, DEEDEE LOUISE (OTA)
Entity Type:Individual
Prefix:MS
First Name:DEEDEE
Middle Name:LOUISE
Last Name:MONTELLO
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HOLLOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2803
Mailing Address - Country:US
Mailing Address - Phone:832-705-8700
Mailing Address - Fax:832-705-8701
Practice Address - Street 1:303 HOLLOW TREE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2803
Practice Address - Country:US
Practice Address - Phone:832-705-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202189224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant