MEDICARE: KATHERINE MONTGOMERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	113574	TX

General Provider Information

NPI Number	:	1619815651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MONTGOMERY

Provider Business Mailing Address
First Line	:	9463 HIGHWAY 377 S UNIT 4030
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 TRAIL LAKE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2030
Country	:	US
Telephone Number	:	817-380-8115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ KATHERINE MONTGOMERY ” Practice Location

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