Provider Demographics
NPI:1720279656
Name:MONTANA, LAURA MARIE (OTR L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:MONTANA
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1503
Mailing Address - Country:US
Mailing Address - Phone:860-919-6423
Mailing Address - Fax:
Practice Address - Street 1:1157 HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:877-271-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist