Provider Demographics
NPI:1952800245
Name:MAXIM, ANGELO JAMES MONTANA (OTD, OTR/L)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:JAMES MONTANA
Last Name:MAXIM
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 STAGHORN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4564
Mailing Address - Country:US
Mailing Address - Phone:330-240-0302
Mailing Address - Fax:
Practice Address - Street 1:2021 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-3030
Practice Address - Country:US
Practice Address - Phone:419-861-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist