Healthcare Provider Details

I. General information

NPI: 1134838311
Provider Name (Legal Business Name): WILLIAM CODY MONTGOMERY OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 SHORT BRANCH DR
TRINITY FL
34655-4424
US

IV. Provider business mailing address

330 WALLER AVE
LEXINGTON KY
40504-2931
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-0182
  • Fax:
Mailing address:
  • Phone: 859-447-8600
  • Fax: 859-447-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0008920
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009879
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27176
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number125649
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7911
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number282530
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: