Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1336148808 |
---|---|
Provider Name | Mrs. Diana Lynn Montgomery |
First Address | Parsons, TN 38363-2429 |
Second Address | Parsons, TN 38363-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31635 | TLC (01) | TN |
4021848 | BCBS (01) | TN |