Provider Demographics
NPI:1003096249
Name:MONTEZON, CECILE VITUALLA (OTR)
Entity type:Individual
Prefix:MRS
First Name:CECILE
Middle Name:VITUALLA
Last Name:MONTEZON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:CECILE
Other - Middle Name:RAMOS
Other - Last Name:VITUALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2384 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-9274
Mailing Address - Country:US
Mailing Address - Phone:815-236-6609
Mailing Address - Fax:
Practice Address - Street 1:2384 LINDEN DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-9274
Practice Address - Country:US
Practice Address - Phone:815-236-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist