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General NPI Number Information
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NPI Number | 1003389248
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Entity Type | Individual
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Provider Name | SONIMARIE H MONTGOMERY
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 2590 WOODLAND DR
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City | COOS BAY
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State | OR
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Zip | 97420-2050
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Country | US
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Telephone | 503-330-1715
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Fax | 541-808-0399
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Provider Business Mailing Address
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Address Line | 95041 STOCK SLOUGH LN
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City | COOS BAY
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State | OR
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Zip | 97420-6348
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Country | US
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Telephone | 503-330-1715
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Fax | 541-808-0399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 13215
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License Number State | OR
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