Provider Demographics
NPI:1245887587
Name:MONTANDON, LEAH (COTA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MONTANDON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 FM 3053 N
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:TX
Mailing Address - Zip Code:75684-6013
Mailing Address - Country:US
Mailing Address - Phone:903-930-8593
Mailing Address - Fax:
Practice Address - Street 1:2711 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1646
Practice Address - Country:US
Practice Address - Phone:903-759-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant