Provider Demographics
NPI:1982954079
Name:BANE, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:HOLLAND BANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3773 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5449
Mailing Address - Country:US
Mailing Address - Phone:775-853-7513
Mailing Address - Fax:775-853-7523
Practice Address - Street 1:3773 BAKER LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5449
Practice Address - Country:US
Practice Address - Phone:775-853-7513
Practice Address - Fax:775-853-7523
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12-0232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGP336ZMedicare PIN