Provider Demographics
NPI:1528685567
Name:MONN, MICAELA (OTR)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:MONN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E RANCIER AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-3450
Mailing Address - Country:US
Mailing Address - Phone:254-781-3447
Mailing Address - Fax:
Practice Address - Street 1:2300 E RANCIER AVE STE 106
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-3450
Practice Address - Country:US
Practice Address - Phone:254-781-3447
Practice Address - Fax:254-227-6163
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist