Provider Demographics
NPI:1437025186
Name:MONTEVILLA, LILYBETH
Entity type:Individual
Prefix:
First Name:LILYBETH
Middle Name:
Last Name:MONTEVILLA
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 1:111 E MONUMENT AVE UNIT 410
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5774
Mailing Address - Country:US
Mailing Address - Phone:407-904-5285
Mailing Address - Fax:407-987-5236
Practice Address - Street 1:111 E MONUMENT AVE UNIT 410
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5774
Practice Address - Country:US
Practice Address - Phone:407-904-5285
Practice Address - Fax:407-987-5236
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13847224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant