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General NPI Number Information
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NPI Number | 1669152005
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Entity Type | Individual
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Provider Name | JANA MARIE MONTGOMERY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 311 EAST COEUR D'ALENE AVENUE
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City | COEUR D'ALENE
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-551-1575
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Fax |
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Provider Business Mailing Address
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Address Line | 12208 N DIAMOND DR
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City | HAYDEN
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State | ID
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Zip | 83835-7909
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Country | US
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Telephone | 316-990-8965
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2477
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License Number State | ID
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