Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 112576 | TX |
NPI | 1124272182 |
---|---|
Provider Name | Tiffany Christeen Montgomery |
First Address | Fort Worth, TX 76109-4214 |
Second Address | Fort Worth, TX 76132-3921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 27/08/2019 |