Healthcare Provider Details

I. General information

NPI: 1154494904
Provider Name (Legal Business Name): LADONNA M MONTGOMERY NON-AID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 GRASSYFORK RD
PEEBLES OH
45660-8911
US

IV. Provider business mailing address

5439 GRASSYFORK RD
PEEBLES OH
45660-8911
US

V. Phone/Fax

Practice location:
  • Phone: 740-493-3734
  • Fax:
Mailing address:
  • Phone: 740-493-3734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: