Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056-005430 | IL |
N | 225X00000X | Occupational Therapist | 1586 | AL |
N | 225X00000X | Occupational Therapist | OT0007107 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 056-005430 | IL |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2534 | GA |
N | 226300000X | Kinesiotherapist | 1263 | FL |
NPI | 1457346769 |
---|---|
Provider Name | Ms. Althea Montgomery |
First Address | Jonesboro, GA 30238-7955 |
Second Address | Jonesboro, GA 30238-7955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 14/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000902195A | (05) | GA |