Provider Demographics
NPI:1528212925
Name:MONTANARO, JAIME NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:NICOLE
Last Name:MONTANARO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21638 REED RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5048
Mailing Address - Country:US
Mailing Address - Phone:315-786-0677
Mailing Address - Fax:
Practice Address - Street 1:21638 REED RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5048
Practice Address - Country:US
Practice Address - Phone:315-786-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist