Provider Demographics
NPI:1073026472
Name:MONTAGUE, SUSAN (OTR/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MONTAGUE
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 1:414 W BAKERVIEW RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8180
Mailing Address - Country:US
Mailing Address - Phone:360-752-5551
Mailing Address - Fax:
Practice Address - Street 1:414 W BAKERVIEW RD STE 110
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8180
Practice Address - Country:US
Practice Address - Phone:360-752-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60647121224Z00000X
WAOT61535586225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant