Provider Demographics
NPI:1124142476
Name:MONTENEGRO, CARLO BARTOLATA (OTR)
Entity type:Individual
Prefix:MR
First Name:CARLO
Middle Name:BARTOLATA
Last Name:MONTENEGRO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 RULEME ST
Mailing Address - Street 2:APT C-35
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6543
Mailing Address - Country:US
Mailing Address - Phone:321-946-1617
Mailing Address - Fax:
Practice Address - Street 1:2800 RULEME ST
Practice Address - Street 2:APT C-35
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6543
Practice Address - Country:US
Practice Address - Phone:321-946-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist