Provider Demographics
NPI:1649502154
Name:MONTEMURRO, ANNA MICHELLE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:MONTEMURRO
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 1:606 SHERBURN CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9017
Mailing Address - Country:US
Mailing Address - Phone:407-883-8636
Mailing Address - Fax:
Practice Address - Street 1:1239 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5417
Practice Address - Country:US
Practice Address - Phone:407-810-2773
Practice Address - Fax:407-867-6203
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA 10860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist