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General NPI Number Information
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NPI Number | 1770780660
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Entity Type | Individual
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Provider Name | DONNA MIA MONTGOMERY MPH,OTR
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7540 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-7967
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Country | US
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Telephone | 888-873-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 N CENTRAL AVE APT 12P
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City | PHOENIX
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State | AZ
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Zip | 85012-1717
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Country | US
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Telephone | 602-680-9564
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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 | 2812
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License Number State | AZ
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