Provider Demographics
NPI:1700524857
Name:MONTIE, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:MONTIE
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:N3708 RIVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-7218
Mailing Address - Country:US
Mailing Address - Phone:715-743-3500
Mailing Address - Fax:715-743-5060
Practice Address - Street 1:N3708 RIVER AVE STE A
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-7218
Practice Address - Country:US
Practice Address - Phone:715-743-3500
Practice Address - Fax:715-743-5060
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679687669Medicaid