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General NPI Number Information
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NPI Number | 1568095560
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Entity Type | Individual
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Provider Name | SHELBY ROSE MONTGOMERY
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Gender | Female
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 6108 COUNTY ROAD 77
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City | MILLERSBURG
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State | OH
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Zip | 44654-9136
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Country | US
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Telephone | 330-893-2610
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Fax |
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Provider Business Mailing Address
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Address Line | 965 W MAIN ST
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City | SUGARCREEK
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State | OH
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Zip | 44681-9315
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Country | US
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Telephone | 740-294-5111
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | COND.20191263-SP
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License Number State | OH
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