Healthcare Provider Details

I. General information

NPI: 1336084862
Provider Name (Legal Business Name): BREANNA R MONTGOMERY BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E JENKINS AVE
COLUMBUS OH
43207-1318
US

IV. Provider business mailing address

596 STINCHCOMB DR APT 3
COLUMBUS OH
43202-1743
US

V. Phone/Fax

Practice location:
  • Phone: 513-740-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: