Provider Demographics
NPI:1447748454
Name:MONTALBO, KATIE MARIE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:MONTALBO
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER ACADEMY
Mailing Address - State:TX
Mailing Address - Zip Code:76554-2846
Mailing Address - Country:US
Mailing Address - Phone:254-721-1394
Mailing Address - Fax:
Practice Address - Street 1:104 N LAMAR ST
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER ACADEMY
Practice Address - State:TX
Practice Address - Zip Code:76554-2846
Practice Address - Country:US
Practice Address - Phone:254-721-1394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS24-015972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program