Provider Demographics
NPI:1811220544
Name:MONZON, CAROL MERCEDES (OT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MERCEDES
Last Name:MONZON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:4520 SW 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 MEDICAL LANE STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1116
Practice Address - Country:US
Practice Address - Phone:239-334-6160
Practice Address - Fax:239-334-1339
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102014000Medicaid
FL001448400Medicaid