Provider Demographics
NPI:1609470251
Name:MONTEITH, CHARMAINE NATALIE
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:NATALIE
Last Name:MONTEITH
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 1:7728 SLOEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-2582
Mailing Address - Country:US
Mailing Address - Phone:786-314-2432
Mailing Address - Fax:352-801-7669
Practice Address - Street 1:7728 SLOEWOOD DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2582
Practice Address - Country:US
Practice Address - Phone:786-314-2432
Practice Address - Fax:352-801-7669
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities