MEDICARE: ERIN MONTGOMERY MS, BCBA

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	103K00000X	Behavior Analyst	1-1728961	CO

General Provider Information

NPI Number	:	1972991842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MONTGOMERY MS, BCBA

Provider Business Mailing Address
First Line	:	1520 E CORTLAND ST
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5704 EUPER LN
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3238
Country	:	US
Telephone Number	:	470-242-4480
Fax Number	:

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

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	09/09/2021

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