Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1883 | SC |
NPI | 1003013517 |
---|---|
Provider Name | Mr. Michael Eugene Montrose |
First Address | Florence, SC 29505-6496 |
Second Address | Florence, SC 29506-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/07/2007 |